Ham C, Maynard A
Health Services Management Centre, University of Birmingham.
BMJ. 1994 Mar 26;308(6932):845-7. doi: 10.1136/bmj.308.6932.845.
The purpose of the present NHS reforms is to introduce a managed market; developing some of the incentives for greater efficiency that are often found in markets while still being able to regulate proceedings to prevent market failures. If government intervenes too much there will be no incentive to improve efficiency and streamline operations: too little intervention may result in some areas having inadequate health service cover or monopoly powers abusing their position. Effective management of the NHS market requires eight core elements: openness of information, control of labour and capital markets, regulation of mergers and takeovers, arbitrating in disputes, protection of unprofitable functions such as research and development, overseeing national provision of health services, protection of basic principles of the NHS, and handling of closures and redundancy. Management of the market would best be performed by the NHS management executive and health authority purchasers acting within a framework set by politicians.
当前英国国民医疗服务体系（NHS）改革的目的是引入一个管理型市场；营造一些通常在市场中能见到的提高效率的激励机制，同时仍能够对相关程序进行监管以防止市场失灵。如果政府干预过多，就不会有提高效率和精简运营的动力：干预过少可能导致一些地区医疗服务覆盖不足或垄断企业滥用其地位。对NHS市场进行有效管理需要八个核心要素：信息公开、劳动力和资本市场管控、合并与收购监管、争端仲裁、保护诸如研发等无盈利的职能、监督全国医疗服务的提供、保护NHS的基本原则以及处理停业和裁员事宜。对市场的管理最好由NHS管理执行官和卫生当局采购方在政治家设定的框架内进行。
