Roberts J A
Department of Health Policy and Planning, London School of Hygiene and Tropical Medicine.
J Public Health Med. 1993 Dec;15(4):305-10. doi: 10.1093/oxfordjournals.pubmed.a042880.
This paper considers the management of markets in the context of the reformed National Health Service (NHS). There are three facets to managing markets: regulating and monitoring markets to ensure that they are competent, managing contracts, and managing agents. The paper considers issues concerned with market structures and entry to and exit from markets; the concept of opportunism is used to explore ways in which self-interested behaviour can operate for good or bad in the setting up of contracts for health care; and factors related to motivating and monitoring agents. The difficulties involved in managing markets are reviewed, and Enthoven is criticized for adopting an over-simplified approach to market management and the abilities of collective agents. The paper concludes by raising questions about the way in which markets are at present being managed in the NHS, and the accountability of purchasers for health care provided and the money spent.
本文探讨了在改革后的国民医疗服务体系（NHS）背景下的市场管理。市场管理有三个方面：规范和监督市场以确保其具备能力、管理合同以及管理代理人。本文考虑了与市场结构以及市场进出相关的问题；运用机会主义概念来探究在医疗保健合同订立过程中自利行为可能产生的好坏影响；以及与激励和监督代理人相关的因素。文中回顾了市场管理所涉及的困难，并批评恩托芬对市场管理和集体代理人能力采取了过于简化的方法。本文最后对目前NHS中市场的管理方式、医疗保健购买者对所提供医疗服务及所花费资金的问责制提出了质疑。
