Enthoven A C
Health Aff (Millwood). 2000 May-Jun;19(3):102-19. doi: 10.1377/hlthaff.19.3.102.
The British National Health Service (NHS) before its 1990s internal-market reforms was a gridlock of perverse incentives. The internal market, an attempt to introduce some market incentives, stimulated much innovation in primary care commissioning and practice improvement and led to increased efficiency. However, its effects were quite limited, because the essential conditions for a market to operate were not fulfilled. There now exists a crisis of confidence in the quality of care in the NHS. It is doubtful whether a culture of innovation, efficiency, and good customer service is possible in a public-sector monopoly whose services are in excess demand and whose units do not get more resources for caring for more patients. It also is doubtful whether the NHS can modernize without consumer choice, competition, and more resources.
20世纪90年代内部市场改革之前的英国国民医疗服务体系（NHS）是一个充满不当激励的僵局。内部市场试图引入一些市场激励措施，刺激了初级医疗保健委托和实践改进方面的大量创新，并提高了效率。然而，其效果相当有限，因为市场运作的基本条件并未得到满足。目前，人们对NHS的医疗质量存在信心危机。在一个服务供不应求且各部门不会因照顾更多患者而获得更多资源的公共部门垄断机构中，是否能形成创新、高效和优质客户服务的文化令人怀疑。同样令人怀疑的是，NHS在没有消费者选择、竞争和更多资源的情况下能否实现现代化。
