Hauck Katharina, Street Andrew
Centre for Health Economics, Monash University, Australia.
Health Econ. 2007 Mar;16(3):275-90. doi: 10.1002/hec.1153.
National priorities and performance management regimes in the National Health Services of England and Wales diverged following devolution, most notably with respect to the use of waiting time targets, which have been progressively strengthened in England but were abandoned in Wales in the immediate post-devolution period. We analyse routine data collected over a six-year period from three English and one Welsh hospital trust close to the English-Welsh border to ascertain whether: (a) there is evidence of differential performance over time that relates to the country where the hospital is located; (b) within each hospital, there is evidence that English and Welsh patients faced different waiting times. Over the period the English hospitals recorded increased levels of activity, undertook proportionately more day case activity, and mortality rates fell. Activity levels remained constant in Wales, the proportion of day case activity fell, proportionately more non-elective patients were admitted, and mortality rates rose. There is partial evidence that English patients faced lower waiting times than their Welsh counterparts and were more likely to be admitted within a target waiting period. The stronger performance management regime operating in England appears to have contributed to higher levels of performance in the English hospitals over the period.
权力下放后，英格兰和威尔士国民医疗服务体系的国家优先事项和绩效管理体制出现了分歧，最明显的是在等待时间目标的使用方面。在英格兰，等待时间目标不断强化，而在威尔士，权力下放后不久就放弃了这一目标。我们分析了从靠近英-威尔士边境的三家英格兰医院信托和一家威尔士医院信托收集的六年常规数据，以确定：(a) 是否有证据表明随着时间推移，医院所在国家与医院绩效存在差异；(b) 在每家医院内部，是否有证据表明英格兰和威尔士患者面临不同的等待时间。在此期间，英格兰医院的活动水平有所提高，日间手术活动比例相应增加，死亡率下降。威尔士的活动水平保持不变，日间手术活动比例下降，非择期入院患者比例相应增加，死亡率上升。有部分证据表明，英格兰患者的等待时间比威尔士患者短，并且更有可能在目标等待期内入院。在此期间，英格兰实施的更强有力的绩效管理体制似乎有助于提高英格兰医院的绩效水平。
