Crampton Peter, Starfield Barbara
Johns Hopkins University, USA.
Int J Health Serv. 2004;34(4):709-27. doi: 10.2190/FMJW-R4R9-C4R1-W8RJ.
Primary care services provide continuing and coordinating care, cater to most health care needs, and serve as a point of first contact with the health system. This article addresses the issue of government ownership of primary care. Ownership confers governance responsibility (ultimate control) for an organization, and accountability for its actions. Primary care organizations can be classed as government owned and operated or privately owned and operated, the latter with or without community governance. The authors address two policy questions: Does the ownership form of a primary care organization matter? What ownership frameworks should be used to guide policymaking? Arguments for and against government ownership are examined from political and economic perspectives, informed by a governance framework. Government ownership of primary care may solve problems associated with private for-profit ownership that are related to lack of control of strategic assets, lack of direct political accountability, contracting, and market failure, but it may raise potential problems of lack of responsiveness to minority and local needs and capture by interest groups. In response to the problems associated with government ownership, community-governed private nonprofits have an essential role as a vehicle for indigenous self-determination, catering for minority populations, experimenting with policy options, and providing public goods particularly for minority populations. The authors argue that private organizations that lack community governance have a lesser role.
初级保健服务提供持续且协调的护理，满足大多数医疗保健需求，并作为与卫生系统的首次接触点。本文探讨了政府对初级保健的所有权问题。所有权赋予一个组织治理责任（最终控制权）及其行动的问责制。初级保健组织可分为政府所有并运营或私人所有并运营，后者有或没有社区治理。作者提出了两个政策问题：初级保健组织的所有权形式重要吗？应该使用哪些所有权框架来指导政策制定？从政治和经济角度，在一个治理框架的指导下，审视了支持和反对政府所有权的论据。政府对初级保健的所有权可能解决与私人营利性所有权相关的问题，这些问题涉及对战略资产缺乏控制、缺乏直接政治问责、合同签订和市场失灵，但它可能引发对少数群体和地方需求缺乏响应以及被利益集团俘获的潜在问题。为应对与政府所有权相关的问题，社区治理的私人非营利组织作为本土自决的工具、满足少数群体需求、试验政策选项以及特别为少数群体提供公共产品方面发挥着重要作用。作者认为缺乏社区治理的私人组织作用较小。
