Braithwaite J
St Vincent's Hospital, Darlinghurst, NSW.
Med J Aust. 1994 Feb 7;160(3):136-9.
Until relatively recently, there have been few attempts to introduce strong forms of competition into publicly funded hospital systems, whether in Australia or elsewhere. The Victorian government has done so by implementing a casemix funding formula from July 1993 and in the process has foreshadowed that the least efficient hospitals will close. While it is of vital importance to improve the efficiency of Australian hospitals, and a key factor is to use casemix funding to achieve microeconomic reform, it is not appropriate to use competition to close hospitals. Arguments against using marketplace forces to determine the fate of hospitals include: the difficulties that could ensue with an inappropriate distribution of hospitals in Victoria; the necessity to provide hospital services for the public good; whether reducing the public sector is actually economically beneficial; and the conclusion reached by many in the United States, that health care should not be treated as a commodity. I argue for the development of a more sophisticated policy than one which uses the principles of laissezfaire and relative efficiency to close public hospitals.
直到最近，无论是在澳大利亚还是其他地方，很少有人尝试将激烈的竞争形式引入公共资助的医院系统。维多利亚州政府自1993年7月起通过实施病例组合资金公式来推行竞争，在此过程中暗示效率最低的医院将会关闭。虽然提高澳大利亚医院的效率至关重要，且利用病例组合资金实现微观经济改革是一个关键因素，但利用竞争来关闭医院并不合适。反对利用市场力量决定医院命运的理由包括：维多利亚州医院分布不当可能引发的问题；为公益提供医院服务的必要性；削减公共部门是否真的具有经济益处；以及许多美国人得出的结论，即医疗保健不应被视为一种商品。我主张制定一项比使用自由放任原则和相对效率来关闭公立医院更为精细的政策。
