Burau Viola
Department of Political Science, University of Aarhus, Denmark.
Health Econ Policy Law. 2007 Oct;2(Pt 4):391-407. doi: 10.1017/S1744133107004264.
The governance of medical performance is changing and new governing instruments are emerging. Existing analyses highlight the complexity of new governance arrangements, but the more or less dualistic perspective limits the possibility for exploring more fully this complexity. The present article therefore uses recent contributions to the literature on governance to explore the co-existence of different forms of governance with the aim of assessing the relative extent and the substantive nature of governance change. Using recent reforms of the governance of medical performance in Germany as a case study, the analysis suggests that the complexity of governance change takes three forms: first, the balance among (hybrid) forms of governance is shifting; second, the nature of individual (hybrid) forms of governance is changing; and, third, both types of change are reflected in tensions not only between but also within (hybrid) forms of governance. As such, the article also contributes to the recent literature on governance by highlighting the centrality of tensions in contemporary governance, which can also occur within both hybrid forms of governance and ;pure' forms of governance.
医疗绩效治理正在发生变化，新的治理手段不断涌现。现有分析突出了新治理安排的复杂性，但或多或少的二元视角限制了更全面探索这种复杂性的可能性。因此，本文运用治理文献中的最新研究成果，探讨不同治理形式的共存，旨在评估治理变革的相对程度和实质性质。以德国近期医疗绩效治理改革为例进行分析，结果表明治理变革的复杂性呈现出三种形式：其一，（混合）治理形式之间的平衡正在发生变化；其二，个体（混合）治理形式的性质正在改变；其三，这两种变革不仅体现在（混合）治理形式之间的紧张关系中，也体现在（混合）治理形式内部的紧张关系中。如此一来，本文还通过强调紧张关系在当代治理中的核心地位，为近期的治理文献做出了贡献，这种紧张关系在混合治理形式和“纯粹”治理形式中都可能出现。
