Bradshaw G, Bradshaw P L
J Nurs Manag. 1994 Jan;2(1):31-6. doi: 10.1111/j.1365-2834.1994.tb00125.x.
This paper examines the factors leading to the introduction of a competitive market in the British National Health Service (NHS). It can be seen that this most radical overhaul in the 45 years of the service was precipitated by economic but also ideological factors. Competition was seen as a means to producing the efficiency that would lead to better health care. The competitive market was introduced without public debate or reference to similar experiences in health care provision in the USA. Little consideration was given to the strengths and weaknesses of such a system. The purchaser-provider model chosen has been expensive to introduce. It has failed to stimulate competition amongst providers and the formal economic evaluation of its performance has so far been minimal. At first sight the separation of purchaser-provider functions has done little to disturb the traditional bureaucratic features of the NHS. The scope exists, however, to open up competition to a much greater extent. Depending on political feasibility, competition would be the necessary mechanism to prepare the NHS for sale into private ownership.
本文探讨了英国国民医疗服务体系（NHS）引入竞争市场的相关因素。可以看出，这项服务45年来最彻底的改革是由经济因素和意识形态因素共同促成的。竞争被视为实现更高效率从而带来更好医疗保健服务的一种手段。竞争市场的引入没有经过公开辩论，也没有参考美国医疗保健服务提供方面的类似经验。对这样一个体系的优缺点几乎没有进行考量。所选择的购买者-提供者模式引入成本高昂。它未能刺激提供者之间的竞争，而且到目前为止对其绩效的正式经济评估微乎其微。乍一看，购买者与提供者职能的分离对NHS传统的官僚特征影响不大。然而，存在进一步扩大竞争范围的空间。根据政治可行性，竞争将是使NHS为出售给私人所有制做准备的必要机制。
