Continuity through change: The rhetoric and reality of health reform in New Zealand
Continuity through change: The rhetoric and reality of health reform in New Zealand
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DOI：
10.1016/j.socscimed.2004.07.004
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发表时间：
2005-07-01
影响因子：
5.4
通讯作者：
Devlin, N
中科院分区：
文献类型：
--
作者：
Ashton, T;Mays, N;Devlin, N
像大多数其他发达经济体一样，新西兰一直在努力建立组织和提供公共资助的卫生保健服务的最佳方式。在1990年代以前，医院和一些相关服务是由以区域为基础的地方选举的保健委员会规划和提供的。1993年，这一制度被准市场结构所取代，由不同的组织负责购买和提供服务。这一制度在2001年被地方选举委员会制度所取代，这一制度与20世纪80年代的制度非常相似。准市场结构的改变和随后的放弃意味着新西兰卫生服务组织方式的重大变化，并表明（至少）在三个关键领域的政策大转变：从合作到竞争（再回来）；从买方和供应商角色的整合到合同安排（并返回）；从地方决策到中央决策（再回来）。本文的目的是考察实践中制度变化的深度，并考虑改革者所陈述的目标在多大程度上掩盖了改革时期之间的连续性。我们的结论是，结构方法之间的简单区分往往不能捕捉到对决策的显著影响。事实上，新西兰并没有像夸夸其谈让我们相信的那样，“进入市场，然后再回到市场”。卫生系统的关键方面在整个改革期间一直存在，可以说这些方面对系统功能和绩效比高层结构变化更为重要。(c) 2004 Elsevier Ltd.版权所有。
New Zealand, like most other developed economics, has struggled to establish the best way of organising and delivering publicly financed health care services. Before the 1990s, hospitals and some related services were planned and provided by regionally based, locally elected health boards. This system was replaced in 1993 with a quasi-market structure in which separate organisations were responsible for the purchasing and provision of services. This in turn was replaced in 2001 by a system of locally elected boards that is remarkably similar to that which existed in the 1980s. The change to and subsequent abandonment of the quasi-market structure implies major changes to the way that health services are organised in New Zealand and suggests policy U-turns in (at least) three key areas: from cooperation to competition (and back); from integration of the roles of purchaser and provider to contractual arrangements (and back); and from local decision-making to centralised decision-making (and back). The aims of this paper are to examine the depth of system change in practice and to consider the extent to which the stated goals of reformers have disguised the degree of continuity between reform eras. We conclude that simplistic distinctions between structural approaches often fail to capture salient influences upon decision-making. New Zealand has not, in fact, been "to market and back" as the rhetoric would have us believe. Key aspects of the health system have endured throughout the reform period and these arguably have more importance for system functioning and performance than the high-level structural changes. (c) 2004 Elsevier Ltd. All rights reserved.