Whynes D K, Reed G
Department for Economics, University of Nottingham.
Br J Gen Pract. 1994 Dec;44(389):557-60.
The introduction of fundholding established an internal market in public sector health care, involving purchasers and providers contracting for the supply of health care.
This study set out to examine fundholders' hospital referral patterns, and to evaluate the quality of the service provided to patients undergoing elective general surgery, as perceived by fundholding general practitioners.
A questionnaire was posted to the senior partners of all fundholding practices in the Trent Regional Health Authority area. This questionnaire requested assessments of the importance of 13 specified aspects of service quality and the quality of provision by general practitioners' most frequently-used hospitals. Five-point scales were employed in each case. Respondents were asked to provide additional details about their practice.
A 67% response rate was achieved. Confidence in the consultant's ability, short waiting times and informative feedback from the providers emerged as the most important elements in referral decisions, while the cost of treatment and patient convenience received lower importance ratings. In terms of how well their providers were seen to perform, fundholders ranked confidence in the consultant and patient convenience highest, and style of hospital management lowest. The majority of referrals seemed to be local.
Judged in terms of fundholders' perceptions, sizeable variations in service quality between hospital providers of general surgery are evident.
基金持有制的引入在公共部门医疗保健领域建立了内部市场，涉及购买者和提供者就医疗保健服务供应签订合同。
本研究旨在调查基金持有者的医院转诊模式，并评估基金持有制的全科医生所认为的为接受择期普通外科手术的患者提供的服务质量。
向特伦特地区卫生局辖区内所有实行基金持有制的医疗机构的高级合伙人发放了一份问卷。该问卷要求评估服务质量13个特定方面的重要性以及全科医生最常使用的医院的服务提供质量。每个方面都采用五分制。受访者还被要求提供其医疗机构的更多详细信息。
回复率为67%。对顾问能力的信心、等待时间短以及提供者提供的信息反馈成为转诊决策中最重要的因素，而治疗费用和患者便利性的重要性评级较低。就他们对提供者表现的看法而言，基金持有者对顾问的信心和患者便利性的评价最高，对医院管理风格的评价最低。大多数转诊似乎是在当地进行的。
从基金持有者的看法来看，普通外科手术医院提供者之间的服务质量存在显著差异。
