Clark D, Neale B, Heather P
Trent Palliative Care Centre, Sheffield, England.
Soc Sci Med. 1995 May;40(9):1193-202. doi: 10.1016/0277-9536(94)00239-p.
In this paper the role of purchasing authorities, as set out in the current U.K. policy literature, is reviewed in the context of recent developments in palliative care. The notion of the purchasing cycle, from need assessment and strategic planning through to contracting and monitoring is outlined, along with core features of recent health and social care legislation in Britain: quality assurance, consumer choice and value for money. The role of providers and service users in the purchasing process is examined and the relationship between purchasers across the health/social care divide is explored. The implications of contracting for the voluntary sector provision of palliative care are also assessed. The review highlights the difficulties under the new legislation in reconciling the aim of efficiency with that of quality assurance, and of separating out the roles of purchasers and providers in a context where palliative care service developments have been provider-led. These factors reinforce the requirement to turn the purchaser-provider split into an effective partnership. Finally, the review highlights the need to address the current imbalances in the purchasing cycle by giving adequate attention to aggregate need assessment and strategic planning.
在本文中，我们结合姑息治疗领域的最新进展，对当前英国政策文献中所阐述的采购当局的角色进行了审视。文中概述了采购周期的概念，从需求评估和战略规划到签约及监督，同时介绍了英国近期健康与社会护理立法的核心特征：质量保证、消费者选择以及物有所值。本文考察了供应商和服务使用者在采购过程中的作用，并探讨了跨越健康/社会护理界限的采购者之间的关系。我们还评估了签约对志愿部门提供姑息治疗的影响。该综述强调，在新立法下，要在效率目标与质量保证目标之间取得平衡存在困难，而且在姑息治疗服务发展由供应商主导的背景下，要区分采购者和供应商的角色也存在困难。这些因素强化了将采购者与供应商的分离转变为有效伙伴关系的必要性。最后，该综述强调需要通过充分关注总体需求评估和战略规划来解决当前采购周期中的不平衡问题。
