如何管理市场？英国和德国的委托模式。
How managed a market? Modes of commissioning in England and Germany.
机构信息
University of Plymouth, UK.
出版信息
BMC Health Serv Res. 2013;13 Suppl 1(Suppl 1):S8. doi: 10.1186/1472-6963-13-S1-S8. Epub 2013 May 24.
BACKGROUND
In quasi-markets governance over healthcare providers is mediated by commissioners. Different commissioners apply different combinations of six methods of control ('media of power') for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. This paper compares how English and German healthcare commissioners do so.
METHODS
Systematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources.
RESULTS
The comparison exposes and contrasts two basic generic modes of commissioning: 1. Surrogate planning (English NHS), in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers. 2. Case-mix commissioning (Germany), in which managerial performance, an 'episode based' negotiated order and juridical controls appear the dominant media of commissioner power.
CONCLUSIONS
Governments do not necessarily maximise commissioners' power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners' use of provider competition as a means of control.
背景
在准市场中，医疗服务提供者由委托方进行管理。不同的委托方会采用不同的六种控制方法（“权力媒介”）的组合来实施治理：管理绩效、协商、话语控制、激励、竞争和司法控制。本文比较了英德两国的医疗保健委托方是如何做到这一点的。
方法
通过多种来源的数据，对六种权力媒介的观察性国家级案例研究进行系统比较。
结果
这种比较揭示并对比了两种基本的委托模式：1. 代理规划（英国 NHS），其中涉及微观委托、供应商竞争、财务激励和处罚的协商秩序是委托方对供应商的主要权力媒介。2. 病例组合委托（德国），其中管理绩效、基于“病例”的协商秩序和司法控制似乎是委托方权力的主要媒介。
结论
政府不一定会通过实施尽可能多的权力媒介来最大化委托方对供应商的权力，因为这些媒介相互作用，有些相互补充，有些相互抑制。特别是，患者对供应商的选择会抑制委托方将供应商竞争作为一种控制手段的使用。
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