改革后的英国国家医疗服务体系（NHS）中“撇脂”的威胁。

The threat of 'cream skimming' in the post-reform NHS.

作者信息

Matsaganis M, Glennerster H

机构信息

London School of Economics.

出版信息

J Health Econ. 1994 Mar;13(1):31-60. doi: 10.1016/0167-6296(94)90003-5.

DOI:10.1016/0167-6296(94)90003-5

PMID:10134438

Abstract

The allocation of budgets to general practitioners to enable them to purchase selected hospital services has been one of the most imaginative elements of the recent National Health Service reforms in Britain. However, reliance on 'historic costs budgeting' has weakened the efficiency incentives of fund-holding, while perpetuating the large variations in resource use endemic in general practice. On the other hand, policy changes aimed to introduce elements of capitation funding, although welcome, raise the spectre of 'cream skimming'. The paper explores the potential for protection against 'cream skimming' offered by incorporating chronic health factors into the formula.

摘要

向全科医生分配预算，使其能够购买特定的医院服务，这是英国近期国民医疗服务体系改革中最具创新性的举措之一。然而，依赖“历史成本预算法”削弱了基金持有制的效率激励作用，同时使得全科医疗中普遍存在的资源使用巨大差异长期存在。另一方面，旨在引入按人头拨款要素的政策变革虽值得欢迎，但引发了“撇脂”的担忧。本文探讨了将慢性健康因素纳入公式以防范“撇脂”的可能性。