London School of Economics and Political Science.
J Health Polit Policy Law. 2012 Aug;37(4):647-64. doi: 10.1215/03616878-1597466. Epub 2012 Mar 30.
Over the past twenty years, the emphasis of reform attempts to improve efficiency within the English National Health Service (NHS) has oscillated between markets and targets. Both strategies are informed by standard economic theory but thus far have achieved varying degrees of success. Behavioral economics is currently in vogue and offers an alternative (or, in some cases, a complement) to standard economic theory on what motivates human behavior. There are many aspects to behavioral economics, but space constraints allow just three to be considered here: identity, loss aversion, and hyperbolic discounting. An attempt is made in this article to speculate on the extent to which these three concepts can explain the success or otherwise of the NHS market and target policies of the last two decades, and some suggestions are offered as to how policies might be usefully designed in the future. Arguably the key points are that people are more likely to be motivated if they identify with the ethos of the policy; the threat of losses will often provoke more of a response than the promise of gains; and the "immediate moment" matters enormously to individuals, so policies that require human action should be designed to make that moment as enjoyable (or as pain free) as possible.
在过去的二十年中，英国国家医疗服务体系（NHS）改革尝试的重点一直在提高效率方面，在市场和目标之间摇摆不定。这两种策略都受到标准经济理论的影响，但迄今为止取得了不同程度的成功。行为经济学目前很流行，为标准经济理论提供了一种替代（或者在某些情况下是补充），以解释激励人类行为的因素。行为经济学有很多方面，但由于篇幅限制，这里只考虑三个方面：身份认同、损失厌恶和双曲线折扣。本文试图推测这三个概念在多大程度上可以解释 NHS 市场和目标政策在过去二十年中的成败，并就如何在未来更有效地设计政策提出了一些建议。可以说，关键是如果人们认同政策的精神，他们就更有可能受到激励；损失的威胁往往比收益的承诺更能引起反应；而且“当下时刻”对个人来说非常重要，因此需要人类采取行动的政策应该设计得使那个时刻尽可能愉快（或无痛苦）。
