Glennerster H, Cohen A, Bovell V
STICERD, London School of Economics, England.
Int J Health Serv. 1998;28(1):47-66. doi: 10.2190/E5MT-HHGH-5AAA-RC1X.
The new Labour government in the United Kingdom is proposing to adapt the reforms begun by the last Thatcher government. In particular, it is proposing to abolish the most controversial element--general practitioner (GP) fundholding. It is looking for alternatives. The study reported here followed and evaluated several such schemes. While fundholders use their purchasing power directly to force change by threatening "exit" to another provider, other GPs have evolved ways of influencing decisions--enhancing their "voice." The authors develop a theory to predict the conditions favoring the relative success of exit and voice strategies in health purchasing, and describe alternative GP-based purchasing schemes and the reasons they evolved in six sample districts. In four of these districts and eight practices in each, fundholding and non-fundholding GPs were then asked to describe their intentions and the outcomes of the purchasing process in which they had participated. Four specialties were taken as examples. The authors compare the relative success of fundholders and non-fundholders in achieving their objectives.
英国新工党政府提议调整上届撒切尔政府开始的改革措施。具体而言，它提议废除最具争议的部分——全科医生（GP）资金持有制。政府正在寻找替代方案。本文所报道的研究跟踪并评估了若干此类方案。资金持有者通过威胁转向其他供应商，直接利用其购买力来推动变革，而其他全科医生则发展出了影响决策的方式——增强其“发言权”。作者提出了一种理论，以预测有利于在医疗采购中相对成功地采用退出和发言权策略的条件，并描述了基于全科医生的替代采购方案以及它们在六个样本地区演变的原因。然后，在其中四个地区以及每个地区的八个诊所中，要求持有资金和不持有资金的全科医生描述他们的意图以及他们所参与的采购过程的结果。选取了四个专科作为示例。作者比较了资金持有者和非资金持有者在实现其目标方面的相对成功率。
