Department of Health Services Research and Policy, LSHTM, London, UK.
Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg.
Health Econ Policy Law. 2020 Jul;15(3):308-324. doi: 10.1017/S1744133119000240. Epub 2019 Sep 6.
Since 1990, market mechanisms have occurred in the predominantly hierarchical National Health Service (NHS). The Health and Social Care Act 2012 led to concerns that market principles had been irrevocably embedded in the NHS and that the regulators would acquire unwarranted power compared with politicians (known as 'juridification'). To assess this concern, we analysed regulatory activity in the period from 2015 to 2018. We explored how economic regulation of the NHS had changed in light of the policy turn back to hierarchy in 2014 and the changes in the legislative framework under Public Contracts Regulations 2015. We found the continuing dominance of hierarchical modes of control was reflected in the relative dominance and behaviour of the sector economic regulator. But there had also been a limited degree of juridification involving the courts. Generally, the regulatory decisions were consistent with the 2014 policy shift away from market principles and with the enduring role of hierarchy in the NHS, but the existing legislative regime did allow the incursion of pro market regulatory decision making, and instances of such decisions were identified.
自 1990 年以来，市场机制已经出现在主要是等级制的国民保健制度（NHS）中。2012 年的《健康与社会关怀法案》（Health and Social Care Act）引发了人们的担忧，即市场原则已经不可逆转地嵌入了国民保健制度，监管机构将获得相对于政治家（被称为“法律化”）的不当权力。为了评估这一担忧，我们分析了 2015 年至 2018 年期间的监管活动。我们探讨了在 2014 年政策回归等级制以及 2015 年《公共合同条例》（Public Contracts Regulations）改变立法框架的背景下，国民保健制度的经济监管发生了怎样的变化。我们发现，等级制控制模式的持续主导地位反映在部门经济监管机构的相对主导地位和行为上。但也存在一定程度的法律化，涉及法院。一般来说，监管决策与 2014 年远离市场原则的政策转变以及国民保健制度中等级制的持久作用是一致的，但现有的立法制度确实允许市场监管决策的介入，并且已经确定了这种决策的实例。
