Curtice Lisa, Fraser Fiona
Nuffield Centre for Community Care Studies, University of Glasgow, Glasgow andCriminology Research Branch (Central Research Unit), Scottish Executive, Edinburgh, UK.
Health Soc Care Community. 2000 Jul;8(4):260-268. doi: 10.1046/j.1365-2524.2000.00248.x.
By offering people the choice of care at home, the policy of encouraging local authorities to purchase domiciliary care services from voluntary and private providers was intended to achieve a key part of the community care agenda. A study to establish the extent to which there was a mixed economy in the purchase and provision of domiciliary care in Scotland in 1996 revealed reluctance by local authority managers to divest the provision of domiciliary care to voluntary and private agencies. In a telephone survey of purchasers, some social work respondents noted a preference for voluntary over private providers and expressed concern as to whether either could take over the bulk of domiciliary care provision. These attitudes were reflected in the pattern of market development observed. Five hundred and ninety providers were identified, but a postal survey of a random sample of one in two providers (response rate 66%) found that the independent sector's share of the market, measured as the proportion of weekly care hours provided, was small compared with the position in England and Wales at that time (15 : 36%). It is concluded that understanding of the development of the quasi-market in domiciliary care in the UK must now take account of slower development in Scotland. Explanation for the difference may lie in the level of state regulation, for in Scotland there was no compulsion on local authorities to purchase from the independent sector. Paradoxically, the quasi-market in England developed through strong state regulation, whereas in Scotland the strength of policy networks may account for the persistence of a more traditional welfare state model. The paper questions whether the incentives for change were sufficient in Scotland under the quasi-market. If local partnerships do not deliver these results the government may have to take a more active role to modernise domiciliary care services.
通过为人们提供在家接受护理的选择，鼓励地方当局从志愿机构和私人机构购买居家护理服务的政策旨在实现社区护理议程的一个关键部分。1996年，一项关于苏格兰居家护理购买和提供方面混合经济程度的研究表明，地方当局管理人员不愿将居家护理服务的提供权下放给志愿机构和私人机构。在对购买者的电话调查中，一些社会工作受访者表示更喜欢志愿机构而非私人机构，并对两者能否接管大部分居家护理服务表示担忧。这些态度反映在观察到的市场发展模式中。共确定了590家服务提供商，但对其中一半提供商进行的随机抽样邮寄调查（回复率为66%）发现，以每周提供的护理小时数比例衡量，独立部门在市场中的份额与当时英格兰和威尔士的情况相比很小（15%：36%）。得出的结论是，现在对英国居家护理准市场发展的理解必须考虑到苏格兰较慢的发展情况。差异的原因可能在于国家监管水平，因为在苏格兰，地方当局没有从独立部门购买服务的强制要求。矛盾的是，英格兰的准市场是通过强有力的国家监管发展起来的，而在苏格兰，政策网络的力量可能解释了更传统的福利国家模式为何持续存在。本文质疑在准市场模式下，苏格兰的变革激励措施是否足够。如果地方合作未能取得这些成果，政府可能不得不发挥更积极的作用，以使居家护理服务现代化。
