Shackley P, Healey A
Department of Public Health, University of Aberdeen, UK.
Health Policy. 1993 Sep;25(1-2):153-68. doi: 10.1016/0168-8510(93)90109-3.
The focus of this paper is the extent to which the purchaser-provider split and the creation of a market in the provision of health care can be expected to bring about greater efficiency within the new NHS. The starting point is a theoretical discussion of markets and competition. In particular, emphasis is placed upon the economic model of perfect competition. It is argued that because of the existence of externalities, uncertainty and a lack of perfect information, an unregulated market in health care will almost certainly fail. In view of this, the imperfect provider markets of monopoly and contestable markets, which are of particular relevance to health care, are discussed. A description of the new health care market and the principal actors within it is followed by an evaluation of the new health care market. It is argued that in view of the restrictions to competition that exist between providers, some form of price regulation will be necessary to prevent monopolistic behaviour in the hospital sector. Regulation of purchasers is also suggested as a means of improving efficiency. It is concluded that competition may be a necessary condition for increased efficiency in health care provision, but is not sufficient in itself. Other incentives in the hospital sector are necessary to assist the market process and to enhance its impact on efficiency.
本文的重点是，在新的国民医疗服务体系（NHS）中，购买者与提供者分离以及医疗保健服务市场的创建在多大程度上有望带来更高的效率。起点是对市场和竞争的理论探讨。特别强调了完全竞争的经济模型。有人认为，由于存在外部性、不确定性以及信息不完全，医疗保健的无管制市场几乎肯定会失灵。有鉴于此，讨论了与医疗保健特别相关的垄断和可竞争市场等不完全提供者市场。在描述新的医疗保健市场及其主要参与者之后，对新的医疗保健市场进行了评估。有人认为，鉴于提供者之间存在竞争限制，某种形式的价格监管对于防止医院部门的垄断行为将是必要的。还建议对购买者进行监管，作为提高效率的一种手段。结论是，竞争可能是提高医疗保健服务效率的必要条件，但仅靠竞争本身并不充分。医院部门还需要其他激励措施来辅助市场进程并增强其对效率的影响。
