The health-care economy is filled with unusual and even unique economic relationships. One of the least understood involves the peculiar roles of producer or “provider” and purchaser or “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 appealing factors of price, quality, and use, and it is the buyer who makes the decision. Such condition, however, is not common 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 rare that a patient 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 the decisions, but in general it is the doctor's judgments that are final. Little wonder then that in the eye 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 physician, the hospital, the patient, and the payer (generally an insurance carrier or government) — the physician makes the essential decisions 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 choices are determined by physicians, not patients. For this reason, the economy directed at patients or the general is relatively ineffective.

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    Watson entered Mr. Smith's office. The boss was a hard man. He fired people who didn't do well without giving them a second chance.

    “Watson, ” said Mr. Smith, “this past year your department hasn't earned money. We're going to drop that department. It's finished. I'm sorry, —but you'll have to go.” “But, sir—if I just had a little more time. For the moment I need the job to keep my son at Riverside School.”

    “What's that!” said the boss. “Riverside! I didn't know you had a boy there. That's an expensive school for a man with your salary.”

    “I know, sir. But he likes it there so much！He's a star athlete and the best boxer in the school. The boys call him Champ (冠军) there.”

    The boss sat perfectly still for a long time—a faraway (恍惚的) look in his eyes. Then, suddenly, he said, “We've got to close your department, Watson. But you'll take over a new job in another department. It means longer hours—maybe more pay. Now get out. You're here for life.”

    Watson got out, with surprise on his face. Then the boss took a letter from the top drawer of his desk. It was Herbie's last letter from Riverside School—written a few days before he died. He had read it over and over again with sick pain. The letter read:

    I can't say the boys here are any nicer to me than the others were. I guess it's the same everywhere when you're a cripple (跛脚的人).

    But don't worry about me, Dad. They've got a good chemistry department here. And there's one boy here who is really great. He's a track star and boxing champ and just tops in chemistry. The boys call him Champ. He made them stop throwing my books around. And he knocked a boy down who hit me. He is the best friend I ever had. Dad, when I grow up, I want to do something for Champ. Something big—that he won't even know about.

Your son

Herbie

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    Will it matter if you don't take your breakfast? Recently a test was given in the United States. Those tested included people of different ages, from 12 to 83. During the experiment, these people were given all kinds of breakfasts, and sometimes they got no breakfast at all. Special tests were set up to see how well their bodies worked when they had eaten a certain kind of breakfast. The results show that if a person eats a proper breakfast, he or she will work with better effect than if he or she has no breakfast. This fact appears to be especially true if a person works with his brains. If a student eats fruit, eggs, bread and milk before going to school, he will learn more quickly and listen with more attention to class.

    Opposite to what many people believe, if you don't eat breakfast, you will not lose weight. This is because people become so hungry at noon that they eat too much for lunch, and end up gaining weight instead of losing. You will probably lose more weight if you reduce your other meals.

Christmas in the United States is traditionally a time of gift-giving and family gatherings. But small towns across the country have their own traditions.

Middleburg, a small town in the state of Virginia, is known for its horses. For more than 50 years, Middleburg has organized a yearly Christmas parade. Men and women ride horses through the woods and fields. They follow hunting dogs as they search for a wild fox. But first, these hunters ride in the yearly parade, wearing their bright red hunting clothes and hats.

John Hale, a citizen of Middleburg says many city people visit his town." We have a lot of people from an urban area that come to visit, but it incorporates a lot of the old traditions." The night-time hayride is one such tradition. Small groups gather under the moonlight on an open wagon (四轮马车) filled with hay (干草). The passengers sing as farm horses pull the wagon slowly across the fields.

There are some newer traditions, too. Trey Matheu works at the nearby Salamander Resort. He says a visit to Middleburg is a chance to slow down for a day. He says Middleburg can be a calming, peaceful place without tension.

"Middleburg is an opportunity to take a step back, to take a deep breath, and understand that even though life is moving on at a very fast pace, there's really an opportunity where you're allowed to step off for a little bit."

Parade organizers say more than 13, 000 people attend even in below freezing weather. But if you ask, you will hear many different reasons why people come to watch the parade:

"I come here because I'm from a small town. I like how everybody comes together."

"I live right down that street, right there. And that's my dog."

Middleburg looks its best at Christmastime. That may be why so many people return each year.