The health-care economy is filled with unusual and even unique economic relationships. One of the least understood involves the peculiar roles of producer of "provider" and purchaser of "consumer" in the typical doctor-patient relationship. In most sectors of the economy, it is the seller who attempts to attract a potential buyer with various inducements of price, quality, and utility, and it is the buyer who makes the decision. Such condition, however, does not prevail in most of the health-care industry.
In the health-care industry, the doctor-patient relationship is the mirror image of the ordinary relationship between producer and consumer. Once an individual has chosen to see a physician—and even then there may be no real choice—it is the physician who usually makes all significant purchasing decisions: whether the patient should return "next Wednesday", whether X-rays are needed, whether drugs should be prescribed, etc. It is a rare and sophisticated patient who will challenge such professional decisions or raise in advance questions about price, especially when the disease is regarded as serious.
This is particularly significant in relation to hospital care. The physician must certify the need for hospitalization, determine what procedures will be performed, and announce when the patient may be discharged. The patient may be consulted about some of these decisions, but it is the doctor’s judgments that are final. Little wonder then that in the eyes of the hospital it is the physician who is the real "consumer". As a consequence, the medical staff represents the "power center" in hospital policy and decision-making, not the administration.
Although usually there are in this situation four identifiable participants—the hospital, the physician, the patient, and the payer (generally an insurance carder or government )—the physician makes the essential for all of them. The hospital becomes an extension of the physician; the payer generally meets most of the bills generated by the physician / hospital, and for the most part the patient plays a passive role. We estimate that about 75-80 percent of health-care expenditures are determined, by physicians, not patients. For this reason, economy directed at patients or the general are relatively ineffective.
With which of the following statements would the author be likely to agree()
A．Few patients are reluctant to object to the course of the treatment prescribed by a doctor or to question the cost of the services.
B．The more serious the illness of a patient, the less likely it is that the patient will object to the course of treatment prescribed or to question the cost of services.
C．The payer, whether insurance carrier or the government, is less likely to acquiesce to demands for payment when the illness of the patient is regarded as serious.
D．The payer makes the final decision as to whether the patient should receive expensive treatment.
