Nordic School of Public Health, Göteborg, Sweden.
Health Policy. 2010 Jul;96(2):91-7. doi: 10.1016/j.healthpol.2010.01.011. Epub 2010 Feb 13.
Despite of an insignificant track record of quasi-market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as "choice of care". This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is "local health care", which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This article reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible. The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a non-competitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals.
尽管瑞典在准市场模式方面的记录微不足道，但最近在医疗保健领域引入了这种新的模式，通常称为“选择护理”。这一次，公民充当购买者；选择他们希望接受治疗的初级保健中心或家庭医生，这反过来又会向所选单位支付人头费。政策制定者认为，此类系统将自我纠正，也就是说，由于竞争，强大的提供者会生存下来，而无利可图的提供者将被淘汰。由于医疗服务碎片化的负面后果，政策制定者同时也在推动各种形式的综合医疗安排。一个例子是“当地医疗保健”，可以被描述为以社区为导向的初级保健升级，由适应性强的医院服务提供支持，以满足当地人口的需求。本文探讨了是否可以将这种综合护理系统与以竞争为导向的治理模式相结合，或者它们是否不兼容。研究结果表明，一些选择护理方案可能会阻碍当地医疗保健的整合发展。然而，像当地医疗保健这样的地理垄断，在非竞争环境中，缺乏竞争的刺激，而竞争可能会提高绩效。因此，可以说，如果选择护理和当地医疗保健应该结合起来，患者应该在综合医疗保健安排之间进行选择，而不是在各个医疗保健专业人员之间进行选择。
