If national health insurance would not cure the problems of the American healthcare system

, what, then, is responsible for them？ Suspicion falls heavily on hospitals, which make up the largest component of the system. In 1988 hospitals accounted for 39% of all health expenditures-more than doctor, nursing homes, drugs, and home health care combined.

Although U.S. hospitals provide outstanding research and frequently excellent care, they also exhibit the classic attributes of insufficient organizations: increasing costs and decreasing use. The average cost of a hospital stay in 1987—$3,850—was more than double the 1980 cost. A careful government analysis published in 1987 revealed the inflation of hospital costs, over and above general price inflation, as a major factor in their growth, even after allowances were made for increases in the population and in intensity of care. While the rate of increase for hospital costs was 2796 greater than that for all medical care and 163% greater than that for all other goods and services, demand for hospital services fell by 34%. But hospitals seemed oblivious of the decline: during this period the number of hospital beds shrank only by about 396, and the number of full-time employees grew by more than 240,000.

After yet another unexpectedly high hospital-cost increase last year, one puzzled government analyst asked: "Where's the money going？" Much of the increase in hospital costs—amounting to $180 billion from 1965 to 1987—went to duplicating medical technology available in nearby hospitals and maintaining excess beds. Modern Healthcare, a leading journal in the field, recently noted that "anecdotes of hospitals' unnecessary spending on technology abound". Medical technology is very expensive. An operating room outfitted to perform. open-heart surgery costs hundreds of thousands of dollars. From 1982 to 1989 the number of hospitals with open-heart-surgery facilities grew by 33%, and the most rapid growth occurred among smaller and moderate-sized hospitals. This growth was worrisome for reasons of both costs and quality. Underused technology almost inevitably decreases quality of care. In medicine, as in everything else, practice makes perfect. For example, most of the hospitals with the lowest mortality rates for coronary-bypass surgery perform. at least fifty to a hundred such procedures annually, and in some cases many more; the majority of those with the highest mortality rates perform. fewer than fifty a year.

According to the passage, the American health-care system______.

A．is working smoothly

B．is the best system in the world

C．is not working efficiently

D．in on the point of collapses