School of Nursing, University of British Columbia, 407-2263 Redbud Lane, Vancouver, BC, Canada.
Health Care Anal. 2010 Mar;18(1):1-16. doi: 10.1007/s10728-008-0106-8. Epub 2008 Nov 5.
In recent years UK government policy has been drawing private companies into the operation of the British National Health Service as providers of health care. Hitherto the National Health Service has been the main employer of health care practitioners, but this may change as a result of this development. There is an issue as to whether professional health care practitioners owe the same moral commitment to an employer in the private sector as they would owe to an employer that is part of the state-run National Health Service. I explore some arguments around this issue, focusing on ways of identifying organisational commitment to good health care. With regard to the practitioners commitment to the organisation I consider two strengths of commitment, normative and calculative. I then undertake an analysis of performance, regulatory regimes, and organisational obligations for both sectors. I conclude that while performance and regulatory regimes show little difference between sectors, there is a reasonably compelling argument in favour of a stronger moral commitment to state bodies based on organisational obligations.
近年来，英国政府的政策一直将私营公司作为医疗保健服务的提供者引入英国国民保健制度的运营中。迄今为止，国民保健制度一直是医疗保健从业者的主要雇主，但由于这一发展，这种情况可能会发生变化。一个问题是，专业医疗保健从业者对私营部门的雇主是否应该承担与国家运营的国民保健制度的雇主相同的道德承诺。我探讨了围绕这个问题的一些论点，重点是确定对医疗保健的组织承诺的方法。关于从业者对组织的承诺，我考虑了承诺的两种力量，规范性和计算性。然后，我对两个部门的绩效、监管制度和组织义务进行了分析。我得出的结论是，虽然绩效和监管制度在两个部门之间几乎没有区别，但基于组织义务，有一个相当有说服力的论点支持对国家机构有更强的道德承诺。
