Cribb Alan
Centre for Public Policy Research, School of Social Science and Public Policy, King's College London, Franklin-Wilkins Building, Waterloo Road, London SE1 9NN, UK.
J Med Philos. 2008 Jun;33(3):221-40. doi: 10.1093/jmp/jhn008.
This paper uses the recent history of marketization and privatization in the UK National Health Service as a case study through which to explore the relationship between health-care organization and health-care goods. Phases and processes of marketization are briefly reviewed in order to show that, although the scope of both marketization and privatization reforms have, until recently, been very heavily circumscribed (and can only be understood in the context of the rise of managerialism), they have nonetheless had a major impact on the "value field" of UK health services. The second half of the paper draws upon the concerns of the critics of market-style reforms to set out and explore the ways in which organizational reform and the shifts in institutional norms consequent upon it construct health-care goods and argues that the investigation of this organization-goods axis ought to have a central place in health-care ethics.
本文以英国国民医疗服务体系近期的市场化和私有化历程为案例研究，借此探讨医疗保健组织与医疗保健产品之间的关系。文章简要回顾了市场化的阶段和过程，旨在表明，尽管直到最近，市场化和私有化改革的范围都受到极大限制（且只能在管理主义兴起的背景下理解），但它们仍对英国医疗服务的“价值领域”产生了重大影响。文章后半部分借鉴了市场式改革批评者的关注点，阐述并探究组织改革及其引发的制度规范转变如何构建医疗保健产品，并认为对这一组织-产品轴的研究应在医疗保健伦理中占据核心地位。
