Ovretveit John
The Nordic School of Public Health, Gothenberg, Box 12133, Sweden, S-40242.
Int J Health Plann Manage. 2003 Jul-Sep;18(3):233-46. doi: 10.1002/hpm.712.
The role of the private sector in public healthcare systems is much debated, but there is little research to inform the debate. In the Nordic countries the extent and type of private sector involvement is largely unknown and the changes and the consequences have not been studied. This paper presents a conceptual framework and some limited data about the changing private-public mix and privatization in the Nordic countries between 1985 and 2000. The data suggest a small increase in both private financing and provision which has accelerated in recent years, especially in specific healthcare fields such as diagnostic centres, dentistry, primary medical care and care for older people. The overall increase is small, but large in certain sectors. Differences between the countries can only be understood in relation to their historical, financial, economic and political context, even though there are many commonalities. Impact also is context dependent, but the findings do show a cross-country pattern of a willingness to experiment and a change in underlying assumptions. The findings show a more extensive interpenetration of private and public than previously recognized but more research is required, especially about changes in recent years about which data are scarce. The paper considers the factors driving these trends, the likely larger changes in the next 10 years and the possible consequences for patients, professionals, managers and governments. It notes the different ways governments can control or influence finance and provision. It proposes that the Nordic and other governments improve regulation and data collection about the private sector and consider influencing private providers through partnership arrangements, rather than leaving the developments to be shaped by growing consumer demands or market logic alone.
私营部门在公共医疗体系中的作用备受争议，但用于为该辩论提供参考的研究却很少。在北欧国家，私营部门参与的程度和类型很大程度上尚不明确，其变化及后果也未得到研究。本文提出了一个概念框架，并给出了一些关于1985年至2000年间北欧国家公私混合情况变化及私有化的有限数据。数据表明，私营融资和服务供给均略有增加，且近年来增速加快，尤其是在诊断中心、牙科、初级医疗保健和老年人护理等特定医疗领域。总体增幅较小，但某些部门增幅较大。尽管各国之间存在许多共性，但只有结合其历史、财政、经济和政治背景才能理解它们之间的差异。影响也取决于具体情况，但研究结果确实显示出一种跨国的试验意愿模式以及基本假设的变化。研究结果表明，公私部门之间的相互渗透比之前认识到的更为广泛，但仍需要更多研究，特别是关于近年来变化的数据，目前这方面的数据很稀缺。本文考虑了推动这些趋势的因素、未来10年可能出现的更大变化以及对患者、专业人员、管理人员和政府可能产生的后果。文中指出了政府控制或影响融资及服务供给的不同方式。建议北欧及其他国家的政府加强对私营部门的监管和数据收集，并考虑通过伙伴关系安排来影响私营服务提供者，而不是任由发展仅由不断增长的消费者需求或市场逻辑来塑造。
