London School of Hygiene and Tropical Medicine, London, UK.
BMC Health Serv Res. 2013;13 Suppl 1(Suppl 1):S1. doi: 10.1186/1472-6963-13-S1-S1. Epub 2013 May 24.
Over the past three decades, a limited range of market like mechanisms have been introduced into the hierarchically structured English National Health Service ('NHS'), which is a nationally tax funded, budget limited healthcare system, with access to care for all, producing structures known as a quasi market. Recently, the Health and Social Care Act 2012 ('HSCA') has been enacted, introducing further market elements. The paper examines the theory and effects of these market mechanisms.
Using neo-classical economics as a primary theoretical framework, as well as new institutional economics and socio-legal theory, the paper first examines the fundamental elements of markets, comparing these with the operation of authority and resource allocation employed in hierarchical structures. Second, the paper examines the application of market concepts to the delivery of healthcare, drawing out the problems which economic and socio-legal theories predict are likely to be encountered. Third, the paper discusses the research evidence concerning the operation of the quasi market in the English NHS. This evidence is provided by research conducted in the UK which uses economic and socio-legal logic to investigate the operation of the economic aspects of the NHS quasi market. Fourth, the paper provides an analysis of the salient elements of the quasi market regime amended by the HSCA 2012.
It is not possible to construct a market conforming to classical economic principles in respect of healthcare. Moreover, it is not desirable to do so, as goals which markets cannot deliver (such as fairness of access) are crucial in England. Most of the evidence shows that the quasi market mechanisms used in the English NHS do not appear to be effective either. This finding should be seen in the light of the fact that the operation of these mechanisms has been significantly affected by the national political (i.e. continuingly hierarchical) and budgetary context in which they are operating.
The organisational structures of a hierarchy are more appropriate for the delivery of healthcare in the English NHS.
在过去的三十年中，一系列有限的市场机制被引入到英国国家医疗服务体系（“NHS”）中，该体系是一个全国性的税收资助、预算有限的医疗保健系统，为所有人提供医疗服务，并形成了所谓的准市场结构。最近，2012 年《健康和社会保健法案》（“HSCA”）已经颁布，引入了进一步的市场元素。本文研究了这些市场机制的理论和效果。
本文首先使用新古典经济学作为主要理论框架，以及新制度经济学和社会法律理论，考察了市场的基本要素，并将这些要素与层级结构中使用的权威和资源分配运作进行了比较。其次，本文考察了市场概念在医疗保健提供中的应用，从中引出了经济和社会法律理论预测可能遇到的问题。第三，本文讨论了关于英国 NHS 准市场运作的研究证据。这些证据来自英国进行的研究，这些研究使用经济和社会法律逻辑来调查 NHS 准市场的经济方面的运作。第四，本文分析了 2012 年《HSCA》修订的准市场制度的显著要素。
在医疗保健方面，不可能构建符合古典经济学原理的市场。此外，这样做也不可取，因为市场无法实现的目标（例如公平的准入）在英国至关重要。大多数证据表明，英国 NHS 使用的准市场机制似乎也没有效果。这一发现应该考虑到这样一个事实，即这些机制的运作受到它们所处的国家政治（即持续的层级制）和预算背景的显著影响。
层级结构的组织结构更适合于英国 NHS 提供医疗服务。
