Smith Tom
Judge Institute of Management Studies, Cambridge University, Cambridge CB2 1AG, UK.
Qual Saf Health Care. 2002 Dec;11(4):383-6. doi: 10.1136/qhc.11.4.383.
Several papers with a common theme published between May and August 2002 are drawn together to present a research-informed critique of economic logic present within recent NHS reform. They attempt to persuade the reader that excessive faith in predictive systems of thought that are underpinned by theories of rational behaviour is misplaced within the NHS. They suggest rational economic theory makes some problematic assumptions about human and individual behaviour. The problem is that there are many modes of thought at work within the NHS, and not all of these cogs are turned by economic rationality. Increasingly, over the last 10 years or so, economic concepts have become more and more prominent in the NHS. Their influence has gone beyond finance becoming a dominant issue. In addition to budgets, contracts and cost itemisation, theoretical relationships of supply and demand are now called upon to change professional behaviour. A new framework for the NHS has been built which is developing market forces. The papers provide some insight into whether the systems set in place to produce a patient-centred service do so in a meaningful way. The first paper examines an emerging primary care group (PCG). Now part of primary care trusts, PCGs were a lynchpin of new economic relationships in the new NHS. Community based, in theory PCGs take decisions made about healthcare resources closer to the patient for whom they are a proxy demander and shaper of services. To what extent do PCGs fulfil this role? The first paper is based on data collected during an in-depth 2 year observation study to test the applicability of health economics to healthcare organisations. It examines the early experience of commissioning services for coronary heart disease (CHD).
2002年5月至8月间发表的几篇主题相同的论文被汇集在一起，对近期英国国家医疗服务体系（NHS）改革中存在的经济逻辑进行基于研究的批判。它们试图说服读者，对以理性行为理论为基础的预测性思维体系过度信任在NHS中是错误的。它们指出，理性经济理论对人类和个体行为做出了一些有问题的假设。问题在于，NHS内部存在多种思维模式，并非所有这些环节都由经济理性驱动。在过去大约10年里，经济概念在NHS中越来越突出。它们的影响已超越财务领域，成为一个主导问题。除了预算、合同和成本明细外，现在还要求供求的理论关系改变专业行为。一个发展市场力量的NHS新框架已经建立。这些论文对为提供以患者为中心的服务而设立的系统是否以有意义的方式做到这一点提供了一些见解。第一篇论文研究了一个新兴的初级保健小组（PCG）。PCG现在是初级保健信托基金的一部分，在新的NHS中是新经济关系的关键。从理论上讲，PCG以社区为基础，将有关医疗资源的决策更贴近它们作为代理需求者和服务塑造者的患者。PCG在多大程度上履行了这一职责？第一篇论文基于一项为期两年的深入观察研究期间收集的数据，以测试卫生经济学在医疗组织中的适用性。它考察了冠心病（CHD）服务委托的早期经验。
