Carnegie Mellon University, Pittsburgh, PA, USA.
J Health Serv Res Policy. 2012 Jan;17 Suppl 1:49-54. doi: 10.1258/jhsrp.2011.011019.
UK governments of all political colours have sought to improve productivity in health care by introducing pro-competitive reforms in the National Health Service (NHS) during the last two decades. The first wave of reform operated from 1991 to 1997. The second wave was introduced in England only in the mid 2000s. In 2010, further reform in England, intended to increase the extent of competition, was proposed by the Coalition administration. But the effect of competition on productivity in health care and in particular on the quality of health care remains a contested issue. This paper reviews the evidence, focusing on robust and recent evidence, on the use of competition as a mechanism for improving quality. The consensus is that competition will increase quality in health care, but that institutional details matter. Given this, we end by discussing whether the current plans to make the buyers of care family doctors and other professionals and to allow some local price variation are likely to be beneficial in the UK context of full public funding for health care.
在过去的二十年里，英国各届政府都试图通过在国民保健制度（NHS）中引入促进竞争的改革来提高医疗保健的生产力。第一波改革始于 1991 年至 1997 年。第二波改革仅在 21 世纪 00 年代中期在英格兰推出。2010 年，联合政府提议在英格兰进行进一步的改革，旨在增加竞争程度。但是，竞争对医疗保健生产力的影响，特别是对医疗保健质量的影响，仍然是一个有争议的问题。本文回顾了证据，重点关注了使用竞争作为提高质量的机制的可靠和最新证据。共识是竞争将提高医疗保健的质量，但制度细节很重要。有鉴于此，我们最后讨论了当前让医疗保健购买者成为家庭医生和其他专业人员，并允许一些地方价格差异的计划是否可能有利于英国全民健康融资的背景。
