Maynard A
York Health Economics Consortium, University of York, UK.
Int J Qual Health Care. 1998 Oct;10(5):379-84. doi: 10.1093/intqhc/10.5.379.
Despite the obvious differences between the USA and UK health care systems, they share the characteristics of being motivated and managed in relation to cost and process rather than quality (the improved health status of patients). Whilst governments and insurers across the world use the rhetoric of quality, they, as epitomized by the behaviours of UK and USA decision makers, fail to define, measure and implement quality outcome policies. These behaviours are examined and some of their causes are explored briefly. Competition, as designed and used in public (e.g. UK National Health Service) and private (e.g. USA managed care) markets is shown to fail both to identify quality outcome targets and to provide evidence-based and efficient mechanisms to motivate decision makers to be orientated towards continuous quality outcome improvement in health care. A central policy challenge is, consequently, not just the measurement of quality outcomes but also their management into practice.
尽管美国和英国的医疗保健系统存在明显差异，但它们都具有在成本和流程而非质量（患者健康状况改善）方面受到驱动和管理的特点。虽然世界各地的政府和保险公司都在谈论质量，但以英国和美国决策者的行为为代表，他们未能定义、衡量和实施质量结果政策。本文对这些行为进行了审视，并简要探讨了其中一些原因。事实表明，公共市场（如英国国民医疗服务体系）和私人市场（如美国管理式医疗）中设计和使用的竞争，既无法确定质量结果目标，也无法提供基于证据且高效的机制，以激励决策者致力于持续改善医疗保健的质量结果。因此，一项核心政策挑战不仅在于衡量质量结果，还在于将其落实到实际管理中。
