Pollitt C
Brunel University.
Health Serv Manage Res. 1993 Feb;6(1):24-34. doi: 10.1177/095148489300600103.
Following the 1989 white paper Working for Patients, medical audit has emerged as the principal officially-approved means of assuring the quality of NHS medical care. Beneath the surface consensus, however, significant arguments continue concerning both the purposes and the character of such audit. A 'medical model' of medical audit is in competition with a more managerial approach, while consumer interests, however unsuccessfully, are also trying to claim a role. Comparison with the system of peer review in the USA indicates that medical audit in the NHS is likely to be particularly weak with respect to public accountability. Nevertheless, when taken together with other features of the white paper's proposals, the universalization of medical audit offers managers an opportunity to begin to constrain the behaviour of hospital doctors at the local level.
继1989年的白皮书《为患者服务》之后，医疗审计已成为官方认可的确保国民保健制度医疗质量的主要手段。然而，在表面的共识之下，关于这种审计的目的和性质仍存在重大争议。医疗审计的“医学模式”与一种更具管理性的方法相互竞争，而消费者利益也在试图发挥作用，尽管成效不佳。与美国的同行评审制度相比，国民保健制度中的医疗审计在公共问责方面可能特别薄弱。然而，与白皮书提议的其他特征相结合，医疗审计的普及为管理者提供了一个机会，使其能够在地方层面开始约束医院医生的行为。
