Black D
J Public Health Policy. 1992 Summer;13(2):156-64.
This paper tries to set the current changes in the British National Health Service in historical perspective. The NHS was born in 1948 amid controversy, both political and professional; but in the 50s and 60s a consensus was reached which won it the support of patients and doctors. But in the 70s and 80s it has undergone the stress of successive reorganizations, in the attempt to meet the economic strains imposed by an ageing population and expensive medical advances. The present changes aim to bring about an "internal market," regulated by contract between "purchases" and "providers." Reasons are given for the view that this artificial arrangement will impair the coherence of the NHS, will add administrative expense and complexity, and will impair the important role of general practitioners as "gate-keepers."
本文试图从历史角度审视英国国民医疗服务体系（NHS）当前的变革。NHS于1948年诞生，当时面临着政治和专业方面的争议；但在五六十年代达成了共识，赢得了患者和医生的支持。然而在七八十年代，它承受了一系列重组带来的压力，试图应对人口老龄化和昂贵医疗进步所带来的经济压力。当前的变革旨在打造一个由“购买方”与“提供方”之间的合同进行监管的“内部市场”。有人认为这种人为的安排将损害NHS的连贯性，增加行政成本和复杂性，并削弱全科医生作为“守门人”的重要作用，文中给出了这样认为的理由。
