Department of Economics, SOAS University of London, London, UK.
Int J Health Serv. 2022 Oct;52(4):480-491. doi: 10.1177/00207314221115945. Epub 2022 Jul 26.
England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms.
英国国家医疗服务体系（NHS）正在进行重大改革，旧有的内部“市场”为基础的机构结构正被整合的医疗系统所取代。这些变化代表着从商业化向医疗服务提供者之间的合作转变的重大转变。但这些政策的实施方式将取决于实施它们的背景，三十年来的新自由主义改革已经对医疗体系的结构产生了影响。本文展示了一个强大的、与政治有联系的金融化私营部门是如何与一个较弱的公共系统一起发展的，而这场大流行病又进一步削弱了公共系统。尽管过去十年中公共卫生支出中流向私营部门的比例并没有大幅增加，但私人金融投资者在一些医疗服务领域，特别是在通过金融工程提高股东回报的精神健康服务领域，已经深深扎根。随着 NHS 为私人患者提供治疗，以及自费医疗服务越来越普遍，公私之间的界限越来越模糊。与传统的私有化不同，医疗系统正面临着不同层面上的公共服务更微妙和更有害的侵蚀，尽管有新的改革，但这种侵蚀似乎仍将继续。
