英国国民健康服务制度的新自由主义改革与反思

Research and Reflection on Neoliberal Reform of the NHS in the UK

新自由主义既是一种经济理论,也是一种意识形态。其过度恐惧政府,反对由政府直接承担社会福利保障,批评英国国民健康服务制度,认为政府应该采取渐进的方式进行改革,退出医疗服务领域,在此领域建立市场机制并维护其运转。20世纪70年代末以来,保守党与工党基于不同的理由,先后转变观念,抛弃了凯恩斯主义,接受了新自由主义及其医疗保障理念,对国民健康服务制度进行了市场化改革,最终建立了"准市场"机制。改革显示出医疗服务与市场机制之间存在一定张力,有必要反思新自由主义界定的政府与市场的关系,正视社会服务的公共属性及价值。

Neoliberalism is both an economic theory and an ideology.Due to the extreme fear of the government,it opposed the nationalized social welfare system,criticized the NHS in the United Kingdom,and advocated a gradual reformation which the government should withdraw from the field of medical services for the public,establish a market mechanism in this field and maintain its operation.Since the late 1970s,for different reasons,the Conservative Party and the Labor Party have successively changed their ideas,abandoned Keynesianism,embraced Neoliberalism and its medical security concept,carried out market-oriented reform of the NHS,eventually established a"quasi-market"mechanism.These reforms show that there is a certain tension between the medical service and the market mechanism.It is necessary to reflect on the relationship between government and market defined by Neoliberalism,face up to the public attribute and value of social service.