Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford OX1 2ER, United Kingdom.
Health Policy. 2023 Dec;138:104941. doi: 10.1016/j.healthpol.2023.104941. Epub 2023 Nov 4.
England's NHS is experiencing rising privatisation as services are increasingly being delivered by private healthcare providers. This has led to concerns about the supposed benefit of this process on healthcare quality but the reasons for the increase - and whether processes prioritise quality - are not well understood. In-depth semi-structured interviews with 20 people involved in the commissioning process, sampled from 3 commissioning sites (regional health boards) are thematically analysed. Four key themes of reasons for outsourcing were identified: unmet need; the "choice agenda"; appetite for change amongst key individuals working at the commissioning body; and the impact of financial pressures. The study concludes that the experience of commissioners navigating the provision of healthcare with worsening social determinants of health and financial austerity means that decisions to use private providers based on anticipated quality are sometimes but not always possible - sometimes they constitute 'accidents', sometimes 'emergencies'.
英国国民保健制度（NHS）正经历着日益严重的私有化，越来越多的医疗服务由私营医疗机构提供。这引发了人们对这一过程对医疗质量带来的好处的担忧，但人们对这一增长的原因（以及这一过程是否优先考虑质量）并不十分了解。我们对参与委托过程的 20 人（从 3 个委托地点[区域卫生委员会]中抽取）进行了深入的半结构化访谈，并对其进行了主题分析。确定了外包的四个主要原因：未满足的需求；“选择议程”；委托机构中关键个人对变革的渴望；以及财政压力的影响。该研究得出的结论是，负责人员在提供医疗服务时遇到了不断恶化的健康社会决定因素和财政紧缩，这意味着根据预期质量做出使用私人供应商的决定有时可行，但并非总是可行——有时这构成了“意外”，有时则是“紧急情况”。
