Light D W
University of Medicine and Dentistry of New Jersey, USA.
Milbank Q. 1997;75(3):297-341. doi: 10.1111/1468-0009.00058.
The United Kingdom led the world in transforming the largest single health care system from a publicly administered service to a set of interlocking contracts. Policy lessons that can be adapted by employers, nations, and other large payers are identified. These lessons are drawn from the improvements that the British made over the design of managed competition, the mistakes and problems they experienced, the underlying trends toward privatization and class discrimination, and the limitations to competition that have led the British toward managed cooperation in collaborative purchasing for the health needs of communities. Yet market reform and the rhetoric of efficiency have justified the shrinking of health services, the shift of costs to household budgets, and the use of public moneys to support private services and investors at greater expense by moving properties and services off the public ledger. In these ways, managed competition can Americanize health care and pose fundamental questions about what policy goals are really being pursued.
英国在将最大的单一医疗保健系统从公共管理服务转变为一系列相互关联的合同方面引领了世界潮流。文中确定了雇主、国家和其他大型付款人可以借鉴的政策经验教训。这些经验教训来自于英国在管理竞争设计方面所做的改进、他们所经历的错误和问题、潜在的私有化和阶级歧视趋势，以及导致英国走向为社区健康需求进行合作采购的管理合作的竞争局限性。然而，市场改革和效率至上的言论为医疗服务的缩减、成本向家庭预算的转移、以及通过将资产和服务从公共账目上移除，以更高成本使用公共资金支持私人服务和投资者提供了正当理由。通过这些方式，管理竞争可能会使美国医疗保健模式化，并引发关于真正追求的政策目标的根本性问题。
