英国国家卫生保健体系改革及其对中国的启示

The National Health Service Reform and Its Implications for China

英国国家卫生保健体系1991年开始促进竞争的改革,具体改革可分为1991-1997年和2002年至今两个阶段。第一阶段改革的主要内容是建立内部市场的框架。第二阶段改革的主要内容是扩大医院经营自主权、赋予和扩大患者就医选择权、建立医院服务信息强制性披露制度及建立按诊断分组付费制度。在第一阶段,竞争降低患者等待时间,未降低医院经营成本,却增加了医院死亡率。在第二阶段,竞争促使医院提高管理水平和医疗服务质量,改善地区间医疗服务获取的公平度。英国国家卫生保健体系促进竞争改革对中国医改的主要启示有两点:其一,建立医疗服务质量和价格的强制性信息披露制度,赋予患者挑选供方的充分权利;其二,实现公立医院实质性的"管办分开",建立完善的公立医院法人治理机制,赋予公立医院经营管理自主权。

The English National Health Service(NHS) started to implement pro- competition reformssince 1991. Specifically, these reforms can be divided into two phases: the former one lastedfrom 1991 to 1997, while the latter began in 2002 and is still in progress. The main content ofthe 1991-1997 reform was to establish the framework of internal market. The second phasefocused on enhancing the managerial autonomy of public hospitals, enlarging patients' choicefor medical providers, establishing mandatory information disclosure system for hospitalservices and implementing a new payment system named‘Payment by Results'. During 1991 and 1997, the pro-competition reform resulted in the reduction of waiting time, but it did notlower the operating cost of hospitals and did increase the morality rate in hospitals. In thesecond stage, the management and clinical quality of hospitals were both improved because ofthe enhanced competition. In addition, due to the pro-competition reform, the geographicalvariation in accessing medical service was substantially decreased. Two implications, thus,can be generated from the pro-competition reform in the English NHS for the health systemreform in China. Firstly, it is essential to establish the mandatory information disclosuresystem on the quality and price of medical service. Additionally, empowering patients with theright to choose medical providers is a key facilitator. Secondly, the establishment ofsubstantial division between management and enforcement in public hospitals is ofsignificance. Correspondingly, together with the enlargement in managerial autonomy, it isrequired that a solid corporate governance system should be set up in public hospitals.