Navarro V
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
Int J Health Serv. 1991;21(3):381-7. doi: 10.2190/VK9M-FJ96-C4PD-Y085.
This article presents a discussion of the relevance of the U.S. experience in general, and health maintenance organizations in particular, to the reforms advocated by the current Conservative government in the general practitioner services of the British National Health Service. The author analyzes empirical information relevant to the assumptions made by the Conservative reformers that (1) the HMO type of practice is better able to respond to people's needs than are current general practitioner arrangements; (2) entrepreneurship in medicine is good for patients; (3) market-based primary care is more efficient than the nonmarket system in the United Kingdom; and (4) the expansion and strengthening of the private sector is an efficient and equitable means of encouraging competition and raising revenues. All of these assumptions are questioned.
本文探讨了美国的经验，尤其是健康维护组织（HMO）的经验，与英国国家医疗服务体系（NHS）中保守党政府当前倡导的全科医生服务改革的相关性。作者分析了与保守党改革者所做假设相关的实证信息，这些假设包括：（1）HMO模式的医疗实践比当前的全科医生安排更能满足人们的需求；（2）医疗领域的创业对患者有益；（3）基于市场的初级医疗保健比英国的非市场体系更高效；（4）私营部门的扩张和强化是鼓励竞争和增加收入的有效且公平的手段。所有这些假设都受到了质疑。
