法国医疗保健体制改革:问责的探索

Reforming the French health-care system:the quest for accountability

20世纪70年代末和80年代,主张亲市场和亲私营部门的新右翼政治兴起(例如,里根经济学和撒切尔主义)(Lorenz,2012),使政府公共服务供给更加依赖私营部门。在法国,对私营部门的支持不再是党派或意识形态的问题,而是一种务实的、日益常态化的提供公共服务的方式。不过,这种方式是否能提高医疗保健体系的效率,仍然值得商榷。本文考察了新公共管理这一理论工具在法国医疗保健体系中的应用(Goldfinch and Wallis,2009:151),检验其运用的选择性,评估其对医疗领域的问责与透明度的影响。法国政府为了达到监督的目的,最终选择了对医疗保健体系的再集权的方式。这种改革对医疗界不利,加强了私人医疗服务的供给。

The resurgence of New Right politics in the late 1970 s and 1980 s(e.g.‘Reaganomics’and‘Thatcherism’),which were pro-market and pro-private sector(Lorenz,2012),has increased the reliance on the private sector for the provision of public services.In France,the support for the private sector is no longer a partisan or ideological issue,but rather a pragmatic and increasingly routine approach to the delivery of public services.Whether this will improve the efficiency of the health-care system is still open to question.The article:investigates the use of the New Public Management toolbox(Goldfinch and Wallis,2009:151)in the French health-care system;examines its selective adoption;and assesses its impact on the accountability and transparency of the medical profession.The French government eventually opted for a re-centralization of the health-care system for monitoring purposes.The reforms antagonized the medical profession and strengthened private care providers.