Brookfield D
Department of Economics and Accounting, University of Liverpool.
J Manag Med. 1994;8(2):17-23. doi: 10.1108/02689239410059598.
The introduction of market forces into the NHS has led to an operational divorce between health care providers and those who need health-care. Central to this change has been the widespread use of contracts. As a management problem, contract negotiation must incorporate consideration of full cost recovery to establish prices for hospital services sold and to ensure that available information is employed in assessing external services purchased. Ignoring the important issue of information availability in identifying relevant costs, it is the difficulty in specifying the cost of an episode of treatment, for example, that has led to contracts being negotiated in block form. Argues that this may be the only contract that can be effectively established. An important consequence of this is that the complexity of hospital services and requirements will work against a wider implementation of piecemeal managed competition and will form a natural barrier to market forces in the NHS.
将市场力量引入英国国家医疗服务体系（NHS）导致了医疗服务提供者与有医疗需求者之间在运营上的分离。这种变化的核心是合同的广泛使用。作为一个管理问题，合同谈判必须考虑全额成本回收，以确定所售医院服务的价格，并确保在评估所购买的外部服务时利用现有信息。例如，在确定相关成本时忽视信息可得性这一重要问题，正是难以明确一次治疗的成本，导致合同以整体形式进行谈判。有人认为这可能是唯一能够有效订立的合同。这一情况的一个重要后果是，医院服务和需求的复杂性将不利于更广泛地实施零散的管理式竞争，并将成为英国国家医疗服务体系中市场力量的一个天然障碍。
