The politics of health care: the NHS under Thatcher
The politics of health care: the NHS under Thatcher
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医疗保健政治：撒切尔夫人领导下的国民医疗服务体系
DOI：
10.1177/026101838500501404
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发表时间：
1985
影响因子：
2.3
通讯作者：
S. Illife
中科院分区：
文献类型：
--
作者：
S. Illife
越来越多地将市场机制引入保健，加速了提供服务的地区差异，使政府难以确定国民保健制度的长期战略。本文从五个主要方面阐述了撒切尔式的方法：限制卫生当局的预算；资本支出;精简国民保健服务的管理；社区护理，以及控制家庭医生服务。保守党政策的可能结果是一个多层次的医疗服务，地区差异很大，较贫穷的地区将依赖最低限度的公共服务，而较富裕的地区将依赖公共和私人提供的混合服务。英国国家医疗服务体系是否存在危机？这个问题的答案取决于如何使用“危机”这个词，以及它在十年来被左派误用的背景下的意义。国民医疗服务体系正在改变，政府正在加快改变的步伐，造成了被称为“危机”的压力和紧张。公共和私人医疗服务之间的平衡正在向右倾斜，这动摇了整个医疗体系，并有可能导致部分医疗体系的崩溃。尽管如此，一项在需要时基本上免费的综合服务继续发挥作用，它在20世纪60年代和70年代的不平等、不平衡、短缺和失败基本上没有改变。关于英国国民医疗服务体系（NHS）内在崩溃的预测已经出现得太频繁、太久了，以至于没有人认真对待。尽管不断崛起的新右翼不断施加压力，而且两党连续几届内阁都受到货币主义的影响，但迄今还没有一届政府敢于放弃公共服务的理念。也没有任何好的证据表明保守党期望或想要废除NHS，尤其是在撒切尔主义被认为正在失败和削弱的时候。除非国民经济发生剧烈变化，或者政治发生更剧烈的变化，否则公共和私人提供的医疗保健平衡的转变将在不同地区以不同的速度进行，几乎不会削弱某些服务，而会改变其他服务。也许对于那些无法理解或无法回应保守党对医疗保健的零敲碎打重建的人来说，这也是一场“危机”？很难知道保守党对NHS的确切策略。我的猜测是，他们没有这样的计划，短期经济利益和意识形态理由的务实结合可能是他们最接近的结果
The increasing introduction of the market mechanism into health care is accelerating the regional variation in provision, and making a long term strategy for the NHS on the part of the government difficult to identify. This article lays out the Thatcherite approach in five main ares: limiting health authority budgets; capital spending; streamlining NHS administration; community care, and the control of Family Practitioner Services. The likely outcom of Conservative policies is a multi-tier health service with wide regional variations where poorer regions will become dependent on a minimal public service and wealthier ones a mixture of public and private provision. Is there a crisis in the NHS? The answer to this depends upon how the term ’crisis’ is used, and its meaning within the context of a decade of mis-use by the left. The National Health Service is changing, and the government is forcing the pace of change, creating the stresses and strains that are labelled ’crisis’. The balance between public and private provision of care is being pushed to the right, shaking the whole structure and threatening to bring parts of it down. Nevertheless, a comprehensive service largely free at the time of need continues to function, with the inequalities, imbalances, shortages and failings it had in the nineteen-sixties and seventies essentially unchanged. Predictions of the immanent collapse of the NHS have been made too often, and for too long, to be taken seriously. No government has yet dared to abandon the idea of a public service, despite constant pressure from the rising New Right and the influence of monetarism on successive cabinets of both parties. Nor is there any good evidence that the Conservatives expect or want to abolish the NHS, especially at a time when Thatcherism is seen to be failing and weakening. Unless there is a dramatic change in the national economy, or an even more dramatic change in politics, the shift in the balance of public and private provision of health care will proceed at different rates in different areas, barely denting some services whilst transforming others. Perhaps there is also a ’crisis’ here for those unable to comprehend or respond to the piecemeal Conservative reconstruction of health care? It is difficult to know the Tories’ exact strategy for the NHS. My guess is that they do not have one, and that a pragmatic mixture of short-term economic interest and ideological justifications may be the nearest they come to