Harrison A J
King's Fund Policy Institute, London, England.
Med Care. 1997 Oct;35(10 Suppl):OS50-61. doi: 10.1097/00005650-199710001-00007.
This article aims to describe recent changes in English hospitals, with particular reference to the impact of the National Health Service (NHS) and Community Care Act of 1990.
Significant policies that have affected the functioning of the hospital sector of the British NHS are reviewed. Data from the NHS Department of Health are used to describe trends in utilization.
The NHS and Community Care Act of 1990 radically changed the financial and organizational framework within which hospitals operate. By creating separate purchasing organizations, the act opened the way for competition between hospitals. In practice, such competition has been very limited. Central directives aimed at reducing waiting times for nonurgent admissions, as well as at raising the volume of work done relative to the finances available have been more significant influences. These changes, combined with rising numbers of emergency admissions, have put the physical and human resources of English hospitals under intense pressure. Admissions have risen, lengths of stay have fallen across all age groups, and ambulatory care has grown rapidly.
There is little consensus on the future direction regarding the role and structure of acute-care hospitals. There is evidence, though, that improvements in the process and outcomes of care are possible within the current financial and organizational framework of the hospital sector.
本文旨在描述英国医院近期的变化，特别提及1990年《国民健康服务（NHS）与社区护理法案》的影响。
回顾了影响英国国民健康服务体系医院部门运作的重大政策。使用国民健康服务部的数据来描述利用趋势。
1990年的《国民健康服务与社区护理法案》从根本上改变了医院运营的财务和组织框架。该法案通过设立独立的采购机构，为医院之间的竞争开辟了道路。实际上，这种竞争非常有限。旨在减少非紧急入院等待时间以及提高相对于可用资金的工作量的中央指令产生了更大的影响。这些变化，再加上急诊入院人数的增加，给英国医院的物力和人力资源带来了巨大压力。入院人数增加，各年龄组的住院时间缩短，门诊护理迅速增长。
关于急症医院的作用和结构的未来方向，几乎没有达成共识。不过，有证据表明，在医院部门当前的财务和组织框架内，护理流程和护理结果有可能得到改善。
