Thehealth-careeconomyisfilledwithunusualandevenuniqueeconomicrelationships．Oneoftheleastunderstoodinvolvesthepeculiarrolesofproduceror"provider"andpurchaseror"consumer"inthetypicaldoctor-patientrelationship．Inmostsectorsoftheeconomy，itisthesellerwhoattemptstoattractapotentialbuyerwithvariousappealingfactorsofprice，quality，anduse，anditisthebuyerwhomakesthedecision．Suchcondition，however，isnotcommoninmostofthehealth-careindustry．

Inthehealth-careindustry，thedoctor-patientrelationshipisthemirrorimageoftheordinaryrelationshipbetweenproducerandconsumer．Onceanindividualhaschosentoseeaphysician-andeventhentheremaybenorealchoice-itisthephysicianwhousuallymakesallsignificantpurchasingdecisions：whetherthepatientshouldreturn"nextWednesday"，whetherX-raysareneeded，whetherdrugsshouldbeprescribed，etc．Itisrarethatapatientwillchallengesuchprofessionaldecisionsorraiseinadvancequestionsaboutprice，especiallywhenthediseaseisregardedasserious．

Thisisparticularlysignificantinrelationtohospitalcare．Thephysicianmustcertifytheneedforhospitalization，determinewhatprocedureswillbeperformed，andannouncewhenthepatientmaybedischarged．Thepatientmaybeconsultedaboutsomeofthedecisions，butingeneralitisthedoctor'sjudgmentsthatarefinal．Littlewonderthenthatintheeyeofthehospitalitisthephysicianwhoisthereal"consumer"．Asaconsequence，themedicalstaffrepresentsthe"powercenter"inhospitalpolicyanddecision-making，nottheadministration．

Althoughusuallythereareinthissituationfouridentifiableparticipants-thephysician，thehospital，thepatient，andthepayer（generallyaninsurancecarrierorgovernment）-thephysicianmakestheessentialdecisionsforallofthem．Thehospitalbecomesanextensionofthephysician；thepayergenerallymeetsmostofthebillsgeneratedbythephysician/hospital，andforthemostpartthepatientplaysapassiverole．Weestimatethatabout75-80percentofhealth-carechoicesaredeterminedbyphysicians，notpatients．Forthisreason，theeconomydirectedatpatientsorthegeneralis