Liu Xingzhu, Hotchkiss David R, Bose Sujata
National Institutes of Health, Fogarty International Center, 31 Center Drive - MSC 2220, Bethesda, MD 20892, USA.
Health Policy Plan. 2008 Jan;23(1):1-13. doi: 10.1093/heapol/czm042. Epub 2007 Nov 13.
The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting-out, which could be either positive or negative. Although the study results leave open the question of how contracting-out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success.
本研究的目的是回顾关于初级卫生保健服务外包的有效性及其对低收入和中等收入国家项目及卫生系统绩效影响的研究文献。由于对改善卫生部门问责关系以及迅速扩大优先干预措施的兴趣日益浓厚，对外包的兴趣和试验也越来越多。总体而言，虽然对所选研究的综述表明，外包在许多情况下改善了服务可及性，但对公平、质量和效率等其他绩效维度的影响往往未知。此外，对于外包的全系统影响知之甚少，其影响可能是积极的，也可能是消极的。尽管研究结果没有解决外包如何作为一种政策工具来改善整体卫生系统绩效这一问题，但结果表明，实施外包的背景和干预措施的设计特征可能会极大地影响成功的机会。
