Universitat de Barcelona, Barcelona, Spain.
University College London, London, UK.
Health Econ Policy Law. 2022 Apr;17(2):220-223. doi: 10.1017/S1744133120000365. Epub 2020 Sep 4.
One of the main governance decisions that policymakers need to make is whether to implement public services via centralized or decentralized forms. As Costa et al. discuss in their article, when public services are implemented via competing systems, service providers contend to provide good services with the ultimate objective of gaining market quota. This is known as managed competition (MC), as the authorities will have to manage the panoply of public and private organizations offering the service. The alternative is to manage the service more centrally, in what it is identified as vertical integration. As the authors describe, several governments around the globe have abandoned their vertical integrated models in favour of decentralized models. This is the case, as the authors recall, for most health services in Europe. While there is an emerging body of evidence suggesting that decentralized MC outperforms vertically integrated models both in terms of efficiency and in terms of service quality, little is known on how these systems react under different circumstances. This means, for example, how these systems can cope with a sudden increase in their service demands.
政策制定者需要做出的主要治理决策之一是，通过集中化还是分散化的形式来提供公共服务。正如 Costa 等人在他们的文章中所讨论的，当公共服务通过竞争系统来实施时，服务提供商竞相提供优质服务，最终目标是获得市场份额。这被称为管理竞争（MC），因为当局将不得不管理提供服务的各种公共和私营组织。另一种选择是更集中地管理服务，这被称为垂直整合。正如作者所描述的，全球有几个政府已经放弃了他们的垂直整合模式，转而采用分散化模式。正如作者所回忆的，欧洲的大多数医疗服务都是如此。虽然有越来越多的证据表明，分散的 MC 在效率和服务质量方面都优于垂直整合模式，但人们对这些系统在不同情况下的反应知之甚少。这意味着，例如，这些系统如何应对服务需求的突然增加。
