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为国民医疗服务体系辩护。

In defense of the national health service.

出版信息

Int J Health Serv. 1980;10(4):611-45. doi: 10.2190/8Y2A-FAL5-3HC4-4E1E.

Abstract

Many influential British groups have taken the opportunity provided by the Royal Commission on the National Health Service to put forward proposals which would fundamentally damage that service. In this paper we discuss the implications of some of these proposals, and explain why we defend the NHS as the basis of an equitable method of providing health care. We consider the various methods which have been suggested to increase the revenue of the NHS. We compare the experiences of several Western countries, and show that the method of financing inevitably affects the pattern of medical care and the indices of health and illness. We examine the underlying motives of many critics of the NHS, and document the development of private medicine in the United Kingdom. We continue by discussing ways in which less money could be spent on health care without detriment to the patient. As an example, we look at several surgical procedures in detail and demonstrate the costs of uncertainty in surgical practice. Finally, we consider the continuing power of the medical profession, how it is maintained, and its implications. We conclude by summarizing why we support the NHS despite its imperfections, and why attempts to undermine it should be resisted.

摘要

许多有影响力的英国团体利用国家医疗服务体系皇家委员会提供的机会,提出了一些将从根本上损害该服务的提议。在本文中,我们讨论了其中一些提议的影响,并解释了我们为何捍卫国家医疗服务体系,将其作为公平提供医疗保健方式的基础。我们考虑了为增加国家医疗服务体系收入而提出的各种方法。我们比较了几个西方国家的经验,并表明融资方式不可避免地会影响医疗模式以及健康与疾病指标。我们审视了许多国家医疗服务体系批评者的潜在动机,并记录了英国私立医疗的发展情况。接着,我们讨论了在不损害患者利益的情况下减少医疗保健支出的方法。例如,我们详细研究了几种外科手术,并展示了外科手术实践中不确定性的成本。最后,我们考虑了医疗行业持续的影响力、其维持方式及其影响。我们总结了尽管国家医疗服务体系存在缺陷,但我们为何支持它,以及为何应抵制破坏它的企图。

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