Gray D J
J R Coll Gen Pract. 1977 Dec;27(185):746-52.
Primary medical care can be provided either by a bureaucratic hierarchical organization or alternatively by independent contractors. Most members of the caring professions in medicine, nursing, and social work are employed in bureaucracies, whereas general medical practitioners, general dental practitioners, opticians, and pharmacists are independent contractors.The independent contractor status has recently been heavily attacked from within the medical and nursing professions, and also from outside. It has been suggested that contracting for services is an inappropriate and anomalous way of arranging medical care, which should now be stopped. However, this process of contracting for services can be analysed, using perspectives from some of the behavioural sciences, to reveal hidden depths in the independent contractor status which suggest that the provision of primary medical care is best carried out by independent contractors.
初级医疗保健既可以由官僚层级组织提供，也可以由独立承包商提供。医学、护理和社会工作等护理行业的大多数成员受雇于官僚机构，而全科医生、普通牙医、验光师和药剂师则是独立承包商。独立承包商的身份最近受到了医学和护理行业内部以及外部的严厉抨击。有人认为，服务合同制是安排医疗保健的一种不适当且异常的方式，现在应该停止。然而，利用一些行为科学的观点，可以对这种服务合同制过程进行分析，以揭示独立承包商身份背后隐藏的深层含义，这表明初级医疗保健最好由独立承包商来提供。
