Joseph A E, Flynn H
Department of Geography, University of Guelph, Ontario, Canada.
Soc Sci Med. 1988;26(1):101-10. doi: 10.1016/0277-9536(88)90049-4.
Concern with the social welfare implications of dual (public and private) hospital systems has grown over the last decade as national commitments to welfare state ideals have wavered in the continuing atmosphere of fiscal conservatism that has permeated through western democracies. New Zealand provides an excellent example of a health care system in which private hospitals have survived (and recently flourished) alongside those provided by the state. Following a brief survey of the evolution of the New Zealand hospital system, variations in the 'mix' of public and private hospitals are described at the (regional) Hospital Board District level. It is noted that competition for patients and funding between the public and private sectors occurs almost exclusively in the larger, urban hospital districts, and is invariably to the detriment of public hospitals. Districts with a substantial private hospital presence are found to have fewer resources in the public sector (relative to their population) than those which have few or no private hospitals. The welfare implications of this situation are explored. It is proposed that the maintenance of a dual hospital system in New Zealand has provided, in some parts of the country at least, a 'choice' for those able to afford private hospital charges or insurance coverage, but at the expense of those dependent solely upon a (shrinking) public sector.
在过去十年中，随着西方民主国家持续弥漫的财政保守主义氛围动摇了各国对福利国家理想的承诺，人们对双重（公立和私立）医院系统的社会福利影响愈发关注。新西兰就是一个很好的例子，其医疗体系中私立医院与公立医院并存（且近年来有所发展）。在简要回顾新西兰医院系统的演变后，本文描述了（地区）医院委员会辖区层面公立和私立医院“组合”的差异。值得注意的是，公立和私立部门之间对患者和资金的竞争几乎只发生在较大的城市医院辖区，而且这必然会损害公立医院的利益。研究发现，与私立医院较少或没有私立医院的地区相比，有大量私立医院的地区公共部门的资源（相对于其人口）更少。本文探讨了这种情况对社会福利的影响。有人提出，在新西兰维持双重医院系统至少在该国的一些地区为那些有能力支付私立医院费用或购买保险的人提供了一种“选择”，但这是以那些完全依赖（不断萎缩的）公共部门的人为代价的。
