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The Market and Health Care Production

市场与保健品生产

基本信息

批准号：
ES/J023108/1
负责人：
Carol Propper
金额：
$ 63.75万
依托单位：
Imperial College London
依托单位国家：
英国
项目类别：
Fellowship
财政年份：
2012
资助国家：
英国
起止时间：
2012 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=ES%2FJ023108%2F1
关键词：
Market Health Care Production

项目摘要

The importance of health care to the economy and society, and its rising cost, mean that governments are constantly searching for ways to increase productivity and promote innovation. The use of market mechanisms in health care is a key component of current reforms to health care delivery in many countries. The political appeal is simple: competition fosters productivity in the rest of the economy, so it will in health care too. But the evidence base is mixed, limited and comes predominantly from the USA, which is an outlier compared to most other health care systems.At the same time as the greater use of market mechanisms has been promoted, from other quarters have come calls for greater integration in health care delivery and doubts raised about whether competition can deliver the step changes required. In the UK at present, for example, there is vociferous opposition to the greater use of market forces in the Coalition government's Health and Social Care Bill. In the USA, Obama's Affordable Care Act includes proposals for greater integration between health care providers and insurers.All these factors mean that understanding the applicability of, and the limits to, market forces in health care is of highest priority. The over-arching question I seek to answer is under what conditions will the greater use of market mechanisms be beneficial for the users and payors of health care services.Within this over-arching question I will address two broad questions: How strong is the support for the use of competition and choice in health care and what evidence is there that integrated care models or command and control can do better? How do market forces affect the labour market and the behaviour of health workers? Within these broad questions, I will address a range of specific issues. These include whether price regulation is needed to make competition in health care work; the role of information in increasing quality; whether choice of family doctors improves their quality; the extent to which production should be concentrated into high volume units, and whether pay structures for managers of public hospitals reward good performance and good management and how not-for-profit hospital behave when faced with competition compared to for-profits.These issues are all central to understanding how health care is best produced. Our present knowledge is partial and this limits the policy makers in their search for solutions that will improve the efficiency of the health care sector. My research agenda will be coupled with a strong impact agenda to translate and disseminate these, and the findings of other scholars, to inform the development of better policy. I have a long track record of active engagement with policy makers and industry participants: this fellowship will give me the opportunity to spend more time ensuring that research findings have maximum impact.

医疗保健对经济和社会的重要性及其不断上升的成本意味着政府正在不断寻找提高生产力和促进创新的方法。在保健方面利用市场机制是许多国家目前保健服务改革的一个关键组成部分。政治诉求很简单：竞争促进了经济其他领域的生产力，医疗保健领域也是如此。但是，证据基础是混合的，有限的，主要来自美国，这是一个离群值相比，大多数其他医疗保健系统。同时，更多地使用市场机制已被提倡，来自其他地区的呼吁，更大的整合在医疗保健提供和质疑是否竞争可以提供所需的步骤变化。例如，目前在英国，联合政府的《卫生和社会保健法案》（Health and Social Care Bill）中就有强烈反对更多地利用市场力量的声音。在美国，奥巴马的《平价医疗法案》包括了加强医疗服务提供者和保险公司之间的整合的建议。所有这些因素都意味着，理解市场力量在医疗服务中的适用性和局限性是最优先考虑的问题。我想回答的一个过于复杂的问题是，在什么情况下，更多地使用市场机制会对医疗服务的使用者和支付者有利。在这个过于复杂的问题中，我将回答两个广泛的问题：在医疗服务中使用竞争和选择的支持程度有多强，以及有什么证据表明综合护理模式或指挥和控制可以做得更好？市场力量如何影响劳动力市场和卫生工作者的行为？在这些广泛的问题中，我将讨论一系列具体问题。这些问题包括：是否需要价格管制来促进保健工作的竞争;信息在提高质量方面的作用;选择家庭医生是否能提高他们的质量;生产应集中到大批量单位的程度，以及公立医院管理人员的薪酬结构是否奖励良好的业绩和良好的管理，以及与营利性医院相比，非营利性医院在面临竞争时的表现如何，利润。这些问题都是理解如何最好地提供医疗保健的核心。我们目前的知识是片面的，这限制了决策者寻求提高保健部门效率的解决办法。我的研究议程将与一个强大的影响议程相结合，以翻译和传播这些，以及其他学者的研究结果，为制定更好的政策提供信息。我与政策制定者和行业参与者有着长期的积极接触记录：这项奖学金将使我有机会花更多的时间确保研究成果产生最大的影响。