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.

    Take part in one of these FUN summer camps.ID Tech Camps offer weeklong courses at locations throughout the US.Our junior courses provide additional time for off-computer activities,ensuring a well-balanced day.Learn from instructors who are passionate about technology.There is a maximum of just 8 students per instructor.Just choose a course.

    Adventures in Games Design

    Ages: 7-10

    Dates: July 1-July 7

    Cost: $520

    Don't just play games!Make them!Create your own video game in this fun,exciting video game camp for kids. Design your own arcade or platform game using professional software.Take breaks to play sports outside and do other activities.

    Adventures in Programming

    Ages: 7-13

    Date: July 4-July 10

    Cost: $750

    Let your imagination run wild in this multimedia adventure.Create your own interactive stories,animated adventures and creative comics.Learn drag-and-drop programming basics with scratch (a project of the MIT Media Lab).Computer characters are at your command!Take breaks with supervised outside sports and activities.

    Adventures in Robotics

    Ages: 12-15

    Date: July 4-July 10

    Cost: $1,200

    Imagine it,build it and watch it go!Powered by the LEGO MINDSTORMS Education NXT Base Set and Software,our Adventures in Robotics course explores the exciting world of robots!This course will have you create cool robots on your first day.

    Introduction to Web Design & Photography

    Ages: 9-12

    Date: July 14-July 20

    Cost: $700

    Use a high-end camera and learn the building blocks of web design with Adobe Dreamweaver.Put your photos into your basic website,and then share your creation with your friends and family.The software Adobe Flash may be introduced based on a student's progress throughout the week.

Movie Making Camp

    Ages: 12-15

    Date: July 14-July 20

    Cost: $1,8000

    Are you ready to learn the basics of filming and editing?

    Shoot with professional cameras and see how much fun creative editing can be with the video editor iMovie. Take home a DVD of your final project to show your family.Please remember it takes filmmakers years to master their skills.Please have realistic project expectations.

    Some people learn a second language easily. Other people have trouble learning a new language. How can you help yourself learn a new language, such as English? There are several ways to make learning English a little easier and more interesting.

    The first step is to feel positive about learning English. If you believe that you can learn, you will learn. Be patient. You do not have to understand everything all at once. It is natural to make mistakes when you learn something new. We can learn from our mistakes. In other words, do not worry about taking risks.

    The second step is to practice your English. For example, write in a journal, or diary, every day. You will get used to writing in English, and you will feel comfortable expressing your ideas in English. After several weeks, you will see that your writing is improving. In addition, you must speak English every day. You can practice with your classmates outside class. You will all make mistakes, but gradually you will become comfortable communicating in English.

    The third step is to keep a record of your language learning. You can write this in your journal. After each class, think about what you did. Did you answer a question correctly? Did you understand something the teacher explained? Perhaps the lesson was difficult, but you tried to understand it. Write these accomplishments in your journal.

    You must be positive about, learning English and believe that you can do it. It is important to practice every day and make a record of your achievements. You will enjoy learning English, and you will have more confidence in yourself.

    Dear Student of Star Middle School:

    As your student council president, I am writing to ask for your support to start the Count-Your-Steps walking program. Mr. Stewart Thomas, a parent of two students at Star Middle School, firstly came up with the idea. Mr. Thomas is a fan of walking and wants to encourage others to appreciate the activity. He shared his idea with our principal, Ms. Howser, who immediately agreed that we should try it.

    Ms. Howser contacted the other middle schools in the district, and all the teachers eagerly adopted the program. Now a team of Count-Your-Steps organizers made up of representatives from the middle schools, has established the program's goal: to increase awareness of the benefits of walking. Organizers want middle school students to accept this challenge and make walking one of their daily activities.

    The program has clear guidelines. Interested participants must only commit to recording the number of steps taken daily. Ms. Earley, the assistant principal, will give each of us a log for recording our steps and a pedometer, which is a small, digital tool used to count the steps of the person wearing it. All participants need to do each day is to wear the pedometer, walk as much as possible, and then record the number of steps in our logs. Clearly, the process is simple and convenient.

    While the benefits of walking are multiple, this challenge offers all who participate the opportunity to work together, achieve success, and make positive changes. Remember that the other schools in the district are signed up for the Count-Your-Steps too, and each one will try to take more steps than our school. I hope many will agree to this challenge and show everyone the Star Middle School Cougar Spirit.

    Please take into careful consideration this valuable and well-planned program, and then sign up today! In the words of Mr. Thomas, “Together we can enjoy the advantages of walking.”

    Sincerely,

    Cora Jeffries

    Long Beach, a 28-mile stretch of beach, lies in southwestern Washington, and it is generally called Long Beach Peninsula (半岛). Communities there take you back to old days of a simple and slow-paced life style. Here, visitors can relax and enjoy the good of total rest.

    Bird Watching

    There are different kinds of birds in Long Beach. It is best if you observe them from a distance and do not try to frighten them. The Southwest Loop Trail Map can be gotten through the Long Beach Peninsula Visitors Bureau Office by calling 1-800-451-2542.

    Horses

    A popular activity in Long Beach is horseback riding. Two businesses in the city of Long Beach offer guided horseback tours along the beach: Back Country Wilderness Outfitters and Skipper's Equestrian Center. You may also bring your own horse. Among the adventures offered with horses is a wagon (四轮马车) ride along the beach, a carriage ride through Sea view or Long Beach, a back country (偏远乡村) packing trip, or a sunset ride by horseback on the beach.

    Camping

    RV (娱乐车) and tent camping aren't allowed on the beach, but there are private camp­ grounds and RV parks in the area, as well as Cape Disappointment State Park. Camp fires are allowed within 100 feet of the beach, but must be away from the dry grass.

    Swimming and Other Activities

    Swimming is allowed, but you must be careful. The waters are very cold and dangerous. Surfing is advised only for experienced surfers. Beach driving is allowed at certain spots on the beach. The speed limit is 25 mph. Building sand castles, digging sand to find something, bicycle riding, and flying kites are also popular activities in the area.

    You can find right hotels easily in the area. Enjoy your trip to Long Beach, Washington!

    There are plenty of mindless activities to keep a child busy in this information age. Yet despite the competition, my 8-year-old daughter Alice wants to spend her leisure time writing short stories. She wants to enter one of her stories into a writing contest, a competition which she won last year.

    As a writer, I know about winning contests—and about losing them. I know what it is like to work hard on a story only to receive a rejection letter from the publisher. I also know the pressure of trying to live up to a reputation created by previous victories. What if she doesn't win the contest again? That's the strange thing about being a parent. So many of our own past scars and destroyed hopes can resurface in our children.

    A revelation (启示) came last week when I asked her, "Don't you want to win again?" "No," she replied. "I just want to tell the story of an angel going to first grade."

    I had just spent weeks correcting her stories as she spontaneously (自发地) told them. Telling myself that I was an experienced writer guiding the young writer across the hall, I offered suggestions for characters, conflicts and endings for her tales. The story about a fearful angel starting first grade was quickly "guided" by me into the tale of a little girl with a wild imagination taking her first music lesson. I had turned her contest into my contest without even realizing it.

    Staying back and giving kids space to grow is not as easy as it looks. Because I know very little about farm animals who use tools or angels who go to first grade, I had to accept the fact that I was co-opting (借鉴) my daughter's experience.

    While stepping back was difficult for me, it was certainly a good first step that I will quickly follow with more steps, putting myself far enough away to give her room but close enough to help if asked. All the while I will be reminding myself that children need room to experiment, grow and find their own voices.