Hughes D, Jost T S, Griffiths L, McHale J V
J Nurs Manag. 1995 Nov;3(6):287-93. doi: 10.1111/j.1365-2834.1995.tb00110.x.
One unexpected point of convergence between the British and North American health care systems is the increased use of negotiated contracts to govern relationships between purchasers and providers. In Britain, the internal market reforms introduced a special regime of National Health Service (NHS) contracts; in the United States there has been a move from disorganization towards integration with the emergence of larger purchasing coalitions and provider organizations. While, in the past, US patients were simply billed for services or assigned claims to the provider, it is now common for payment to be made directly from purchaser to provider and for the terms of these transactions to be set out in contracts. This paper draws on the reading of contracts, interviews with contracting parties, and ongoing research on NHS contracting in Wales to compare contracting practice within the two systems. It examines how the very different environments of the public, hierarchically-regulated NHS and the private health care market of the US influence the detailed content of contract clauses. The analysis passes over similarities, different solutions to common problems, and fundamental differences of approach, before considering the possibilities for transfers of contracting 'technology'.
英国和北美医疗保健系统之间一个意想不到的交汇点是，越来越多地使用协商合同来管理购买方与供应商之间的关系。在英国，内部市场改革引入了国民医疗服务体系（NHS）合同的特殊制度；在美国，随着更大的采购联盟和供应商组织的出现，出现了从无序到整合的转变。过去，美国患者只需为服务付费或向供应商提交索赔，而现在，通常是由购买方直接向供应商付款，并在合同中规定这些交易的条款。本文通过研读合同、采访合同双方以及对威尔士国民医疗服务体系合同的持续研究，比较了这两个系统中的合同实践。它考察了公共的、层级管理的国民医疗服务体系与美国私人医疗保健市场这两种截然不同的环境如何影响合同条款的详细内容。在考虑合同“技术”转移的可能性之前，该分析忽略了相似之处、对常见问题的不同解决方案以及方法上的根本差异。
