英国国民医疗服务制度发展和启示

Development and Insights of the National Health Service in the UK

受苏联“免费”医疗服务体系的间接影响,英国于1948年建立国民医疗服务制度,至今已运行70多年。在其发展历程中,管理方式经历了从最初的行政指令到后续的管理体制改革,再到当前强调机构间的合作与整合的演变。虽然政策工具发生了诸多变化,但制度创建时的理念却一直沿用至今。强调公平、保护弱势群体和发展社区医疗服务一直是其持续发展的重要基石。英国国民医疗服务体系常被拿来与中国的医疗保障体系进行比较,并在国内学术界和公众中引起了广泛关注。然而,由于中英两国的经济发展水平、人口结构和医疗需求等因素存在较大差异,简单比较单一指标容易导致误导性结论,英国单项成功政策并不一定适应我国国情。因此,全面认识英国国民医疗服务体系的制度理念和运行现状,而非仅限于单一政策工具和指标,对于构建与中国式现代化相适应的医疗保障制度具有重要意义。

The United Kingdom established the National Health Service(NHS)in 1948,indirectly infl uenced by the Soviet Union's model of"free"healthcare.Over the past 76 years,its governance has evolved from a command-and-control approach to reforms in management mechanisms,now focusing on integration and collaboration among various institutions.Despite changes in policy tools,the foundational institutional principles—emphasizing equity,protecting vulnerable groups,and promoting community-centric healthcare—have remained intact.Cross-national comparisons of the healthcare systems in China and the United Kingdom have drawn considerable attention from academics and the public in China.However,signifi cant diff erences in economic development,demographic structure,and healthcare needs mean that comparing individual performance indicators can be misleading.A cost-effective policy instrument in the United Kingdom may not necessarily suit China's context.Therefore,it is crucial to gain a deeper understanding of the philosophy underpinning the NHS and its contemporary policies,rather than merely focusing on individual policy instruments and indicators,to develop a healthcare system aligned with China's path to modernization.