Best G, Knowles D, Mathew D
King's Fund College, London.
BMJ. 1994 Mar 26;308(6932):842-5. doi: 10.1136/bmj.308.6932.842.
The essence of the NHS reforms is that they bring market forces to bear on organisations providing public services, while allowing those organisations more freedom to respond in ways that will improve the efficiency, effectiveness, and appropriateness of their services. The new structural changes to the NHS--a leaner management executive and fewer, slimmer regions--could be used either to strengthen these features of the reforms or frustrate them by allowing ministers and top management to intervene even more at local level and "overmanage" the market. To ensure that the aims of the reforms are not frustrated ministers and the management executive must restrict themselves to laying down clear strategies and then allow purchasers and providers to meet those strategies in their own ways. They also need to ensure that the whole NHS can learn and benefit from local experimentation and devise ways of managing the crises that will inevitably arise; otherwise they might be tempted to become involved in managing the market at too local a level, and the NHS will suffer the worst of both worlds: stifling bureaucracy at the top and parochial self interest locally.
英国国家医疗服务体系（NHS）改革的核心在于，将市场力量施加于提供公共服务的组织，同时给予这些组织更大的自由，使其能够以提高服务效率、效力和适宜性的方式做出回应。NHS的新结构变革——精简管理执行层以及减少且缩小地区规模——既可以用来强化改革的这些特征，也可能因允许部长和高层管理人员在地方层面进行更多干预并对市场进行“过度管理”而使改革受挫。为确保改革目标不被挫败，部长们和管理执行层必须仅限于制定明确的战略，然后让采购方和供应方以各自的方式实现这些战略。他们还需要确保整个NHS能够从地方试验中学习并受益，并设计出应对必然会出现的危机的方法；否则，他们可能会倾向于在过于地方化的层面介入市场管理，而NHS将遭遇最糟糕的情况：高层存在令人窒息的官僚作风，地方则存在狭隘的私利行为。
