How will Brexit affect health services in the UK? An updated evaluation
How will Brexit affect health services in the UK? An updated evaluation
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DOI：
10.1016/s0140-6736(19)30425-8
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发表时间：
2019-03-02
期刊：
影响因子：
168.9
通讯作者：
McKee, Martin
中科院分区：
文献类型：
--
作者：
Fahy, Nick;Hervey, Tamara;McKee, Martin
所有形式的脱欧都不利于健康，但有些比其他形式更糟糕。本文以我们 2017 年的分析为基础，使用世界卫生组织卫生系统构建模块框架来评估英国脱欧对英国国民医疗服务体系 (NHS) 的可能影响。我们考虑以下四种可能的情况： 无协议脱欧，即英国于 2019 年 3 月 29 日离开欧盟，且未就脱欧条款达成任何正式协议；英国和欧盟之间谈判达成的脱欧协议，等待（可能的）正式协议，该协议提供了截至 2020 年 12 月底的过渡期； 《北爱尔兰议定书》的保障措施在此期限结束后生效；或《英国与欧盟未来关系政治宣言》。我们的分析表明，无协议脱欧对国民医疗服务体系（NHS）来说比涉及脱欧协议的未来更糟糕，脱欧协议提供了法律关系的确定性和连续性，同时就未来关系的政治宣言进行谈判并将其付诸法律形式。北爱尔兰保障措施具有不同的影响，在某些领域具有连续性，例如保健产品，但在其他领域则没有连续性。 《未来关系政治宣言》设想了一种以自由贸易协定为中心的关系，其中基本上不存在更广泛的健康相关问题。然而，所有形式的脱欧都会对英国在欧洲和全球范围内的领导力和卫生治理产生负面影响，并对议会和其他利益相关者审查和监督政府行为的能力产生质疑。
All forms of Brexit are bad for health, but some are worse than others. This paper builds on our 2017 analysis using the WHO health system building blocks framework to assess the likely effects of Brexit on the National Health Service (NHS) in the UK. We consider four possible scenarios as follows: a No-Deal Brexit under which the UK leaves the EU on March 29, 2019, without any formal agreement on the terms of withdrawal; a Withdrawal Agreement, as negotiated between the UK and EU and awaiting (possible) formal agreement, which provides a transition period until the end of December, 2020; the Northern Ireland Protocol's backstop coming into effect after the end of that period; or the Political Declaration on the Future Relationship between the UK and EU. Our analysis shows that a No-Deal Brexit is substantially worse for the NHS than a future involving the Withdrawal Agreement, which provides certainty and continuity in legal relations while the Political Declaration on the Future Relationship is negotiated and put into legal form. The Northern Ireland backstop has varying effects, with continuity in some areas, such as health products, but no continuity in others. The Political Declaration on the Future Relationship envisages a relationship that is centred around a free-trade agreement, in which wider health-related issues are largely absent. All forms of Brexit, however, involve negative consequences for the UK's leadership and governance of health, in both Europe and globally, with questions about the ability of parliament and other stakeholders to scrutinise and oversee government actions.