Newton J, Fraser M, Robinson J, Wainwright D
Department of Applied Social Science, University of Northumbria, Newcastle upon Tyne.
BMJ. 1993 Feb 6;306(6874):375-8. doi: 10.1136/bmj.306.6874.375.
To describe the experiences of 10 fundholding practices in the Northern region during 1991-2 and to elicit subjective assessments of the impact of their change in status on practice management and patient care.
Semistructured interviews were conducted with clinicians and practice managers; other staff in the practices were asked to fill in questionnaires. Questions were asked about the preparatory year, the impact of fundholding on clinical practice and practice management, perceptions of the costs and benefits of fundholding, and views about the future of the scheme.
10 of the 28 first wave fundholding practices in the Northern region, March-July 1992.
Two interviews were conducted in nine practices and one interview in the tenth practice. Replies to the questionnaire were received from 35 general practitioners (73%) and 89 (58%) nonmedical staff. Practices sought independence in applying for fundholding status and found the preparatory year challenging and time consuming. General practitioners thought that the greatest change had occurred in relationships with consultants and the least change in relationships with patients. Most respondents thought that fundholding had changed the way they worked. The perceived benefits of fundholding were mentioned more often than the perceived costs.
The results offer some encouragement to the proponents of fundholding, but more longitudinal studies are needed to evaluate the misgivings of critics of the scheme. Fundholders are uncertain about their ability to make savings year after year, particularly in an increasingly cost contained environment.
描述1991 - 1992年间北部地区10家基金持有型医疗机构的经历，并获取对其地位变化对医疗机构管理和患者护理影响的主观评估。
对临床医生和医疗机构管理人员进行半结构化访谈；要求医疗机构的其他工作人员填写问卷。问题涉及筹备年、基金持有对临床实践和医疗机构管理的影响、对基金持有成本和收益的看法以及对该计划未来的看法。
1992年3月至7月，北部地区28家首批基金持有型医疗机构中的10家。
9家医疗机构进行了两次访谈，第10家医疗机构进行了一次访谈。收到了35名全科医生（73%）和89名非医务人员（58%）对问卷的回复。医疗机构在申请基金持有地位时寻求独立，并发现筹备年具有挑战性且耗时。全科医生认为与顾问的关系变化最大，与患者的关系变化最小。大多数受访者认为基金持有改变了他们的工作方式。提及基金持有带来的好处的受访者比提及成本的更多。
研究结果给基金持有支持者带来了一些鼓舞，但需要更多纵向研究来评估该计划批评者的担忧。基金持有者对自己年复一年节省开支的能力不确定，尤其是在成本控制日益严格的环境中。
