The NHS at 60: Perspectives on Health Care Systems
The NHS at 60: Perspectives on Health Care Systems
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NHS 60 周年：医疗保健系统视角
DOI：
10.1093/shm/hkn081
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发表时间：
2008
影响因子：
0.7
通讯作者：
O. Moscucci
中科院分区：
文献类型：
--
作者：
O. Moscucci
英国国民健康服务体系（NHS）于1948年7月5日成立。为了纪念其钻石周年纪念日，这期杂志刊登了四篇特别委托撰写的文章，从历史、社会学和比较的角度研究了医疗保健系统。正如迷迭香史蒂文斯在国民保健服务50岁时所观察到的那样，周年纪念对历史学家来说是有用的，“因为它们需要盘点并产生新的工作”。1.这些专题文章也是回顾过去，展望未来。在提供各种国家背景下的医疗保健历史和史学的一系列观点时，他们试图激发关于方法和方法的辩论，这些方法和方法可能会进一步加深我们对二战后改革复杂而有争议的历史的理解。卫生大臣Aneurin Bevan在介绍时将NHS描述为“世界上有史以来最大的社会服务实验”。2这项新的服务实现了雄心勃勃的计划，即提供一个由税收资助的医疗保健系统，向所有人提供，在使用时免费。尽管一开始就引发了激烈的争论，但NHS很快成为英国最受欢迎的机构。历届政府都对其组织结构进行了修补，但其基本架构保持不变。正如马丁·戈尔斯基（Martin Gorsky）在他的史学调查中所观察到的那样，这使得国民保健制度成为一个“既小又易管理，又大又笨拙”的研究领域。除了其内在的复杂性，国民保健制度的历史一直困扰着尖锐的意见分歧，其起源和随后的改革的价值，特别是在撒切尔时代。这并不奇怪，因为NHS一直充当着“意识形态裂缝的避雷针”，对一些人来说，它体现了社会团结和分配正义的理想，对另一些人来说，它体现了官僚主义和老式家长式作风的邪恶。过分夸张的说法是战后福利国家适应了消费社会的到来，但历史学家对最近改革的影响以及它们为未来设定的轨迹仍然存在严重分歧，英国NHS的历史发展可以被视为20世纪世纪前几十年大多数欧洲国家共同的模式。首先是建立旨在缓解极端贫困的社会保障制度。这些逐渐被基于普遍性和收入替代原则的社会保障形式所取代。美国没有遵循这种模式，1935年才建立社会保障，当时还不包括医疗保险。因此，在美国政治中，“改革”一词通常意味着扩大保险，而不是像英国那样合理化或改善服务。在20世纪60年代，美国政府推出了医疗保险（针对老年人）和医疗补助（针对低收入人群），但随后对该系统进行改革的努力被证明是失败的。除了对全民健康的“未完成的追求”之外，
Britain’s National Health Service (NHS) came into being on 5 July 1948. To mark its diamond anniversary, this issue of the journal features four specially commissioned articles that examine health care systems in historical, sociological and comparative context. As Rosemary Stevens observed when the NHS turned 50, anniversaries are useful to historians,‘for they require stock-taking and generate new work’. 1 These special articles likewise look back to the past with an eye to the future. In offering a range of perspectives on the history and historiography of health care in a variety of national settings, they seek to stimulate debate about the methods and approaches that might further our understanding of the complex and controversial history of reform in the post-Second World War era. At its introduction, Aneurin Bevan, the Secretary of State for Health, described the NHS as ‘the biggest single experiment in social service that the world has ever seen undertaken’. 2 The new service fulfilled ambitious plans to provide a system of health care funded by taxation, available to the whole population and free at the point of use. Despite engendering fierce debate at its beginning, the NHS quickly became the UK’s most popular institution. Successive governments have tinkered with its organisational structure, but its basic architecture remains intact. This makes the NHS a field of study that is at once ‘small and manageable, and vast and unwieldy’, as Martin Gorsky observes in his survey of the historiography. In addition to its intrinsic complexity, the history of the NHS has been bedevilled by sharp differences of opinion over its origins and the value of subsequent reforms, particularly during the Thatcher era. This is not surprising as the NHS has always acted as a ‘lightening conductor for ideological fissure’, epitomising for some the ideals of social solidarity and distributional justice, for others the evils of bureaucratic inflexibility and old-fashioned paternalism. The over-arching narrative is the adaptation of the post-war welfare state to the coming of a consumer society, but historians remain deeply divided over the impact of recent reforms and the trajectories they have set for the future.The historical development of the British NHS can be seen to exemplify a pattern common to most European states during the early decades of the twentieth century. First came the establishment of social security systems aimed at easing extreme poverty. These were gradually superseded by forms of social security based on the principles of universality and earnings substitution. This pattern was not followed in the United States, where social security was only established in 1935, and then it did not include health insurance. Consequently, the word ‘reform’in US politics has usually meant extending insurance, not rationalising or improving services, as it has in Great Britain. During the 1960s, the US government introduced Medicare (for the elderly) and Medicaid (for those on low income), but subsequent efforts to overhaul the system have proved unsuccessful. Alongside this ‘unfinished quest’for universal health