West P A
St Thomas Hospital, London, UK.
Health Policy. 1998 May;44(2):167-83. doi: 10.1016/s0168-8510(98)00016-5.
This paper argues that the British NHS Reforms (the 'Reforms') set out in Working for Patients [1] largely failed to create a market, to achieve the changes that market forces might have been expected to achieve or to meet the objectives set for the NHS in Working for Patients. It draws on the available literature and the author's experience of work with the NHS during the 6 years after Working for Patients. It is hampered, as are all such reviews of the UK Reforms, by the lack of a detailed and systematic research appraisal of the internal market. Many small changes, resulting from market mechanisms, may have occurred throughout the NHS without being publicized or well documented. But overall, there is little convincing evidence that the Reforms have achieved their goals or met the objectives of the politicians who initiated them. The argument here is necessarily limited by the space available (but see [2] for a detailed analysis of the NHS Reforms). The initial sections of the paper examine the characteristics of markets and market power and the extent to which the NHS Reforms created a market, with health authorities and fund-holders as its buyers. The paper concentrates in particular on health authorities. Later sections then examine the extent to which the Reforms met the objectives set out in Working for Patients.
本文认为，《为患者服务》[1]中提出的英国国民医疗服务体系改革（以下简称“改革”）在很大程度上未能创建一个市场，未能实现市场力量本应达成的变革，也未能达成《为患者服务》中为国民医疗服务体系设定的目标。本文借鉴了现有文献以及作者在《为患者服务》发布后的6年里在国民医疗服务体系工作的经验。与所有对英国改革的此类评估一样，本文受到了缺乏对内部市场进行详细系统研究评估的阻碍。国民医疗服务体系中可能因市场机制而发生了许多小的变化，但这些变化并未得到宣传或充分记录。但总体而言，几乎没有令人信服的证据表明改革实现了其目标，或达到了发起改革的政治家们的目的。这里的论证必然受到篇幅限制（但有关国民医疗服务体系改革的详细分析，请参阅[2]）。本文开篇部分考察了市场和市场力量的特征，以及国民医疗服务体系改革创建市场的程度，其中卫生当局和基金持有者为买方。本文特别关注卫生当局。随后的章节则考察了改革在多大程度上实现了《为患者服务》中设定的目标。
