Klein R
Milbank Mem Fund Q Health Soc. 1979 Winter;57(1):70-94.
The experience of Britain's National Health Service since 1948 suggests that there is a conflict between different social values and policy aims, and that progress toward achieving more community or worker control is constrained by the pursuit of other desired objectives. The egalitarian ideology of the NHS emphasizes central control to achieve a nationally equitable distribution of resources. Emphasis on coordination between the NHS and other social services limits freedom of action. Democracy as accountable policy-making on a national scale may therefore be incompatible with democracy as direct control, whether by community or workers. To encourage participation means accepting diversity in the provision of health care and the multiplication of small, self-governing units. Similarly, worker control is professional autonomy writ large and may therefore conflict with community control.
自1948年以来，英国国家医疗服务体系的经验表明，不同的社会价值观与政策目标之间存在冲突，而且在实现更多社区或工人控制方面取得的进展受到对其他期望目标的追求的限制。国家医疗服务体系的平等主义意识形态强调中央控制，以实现全国范围内资源的公平分配。对国家医疗服务体系与其他社会服务之间协调的强调限制了行动自由。因此，全国范围内可问责的政策制定形式的民主可能与社区或工人直接控制形式的民主不相容。鼓励参与意味着接受医疗保健提供方面的多样性以及小型自治单位的增加。同样，工人控制是放大了的专业自主权，因此可能与社区控制相冲突。
