Howden-Chapman P, Ashton T
Department of Public Health, Wellington School of Medicine, Wellington South, New Zealand.
Health Policy. 1994 Jul-Aug;29(1-2):61-83. doi: 10.1016/0168-8510(94)90007-8.
The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population.
1993年新西兰医疗服务改革基于所谓的购买者/提供者分离所带来的效率提升。购买者需要为维持、改善和恢复其服务人群健康的服务签订合同。购买角色既需要发展合同签订技能，又需要设定战略方向和优先事项，这是新出现的且目前发展不足。本文描述了购买代理在设定优先事项方面的作用、服务合同签订所采用的不同方法以及合同签订第一年出现的一些问题。探讨了通过可竞争合同提高效率的潜力与尽量减少合同签订过程相关交易成本的需求之间明显的权衡。在购买者塑造公共卫生服务和改善人群健康角色的更广泛政治背景下，分析了购买者对公众和部长的问责制。
