The Market and Health Care Production

医疗保健对经济和社会的重要性及其不断上升的成本，意味着各国政府正在不断寻找提高生产率和促进创新的方法。在卫生保健中使用市场机制是许多国家目前卫生保健提供改革的一个重要组成部分。政治诉求很简单：竞争促进了经济其他领域的生产率，医疗保健领域也是如此。但证据基础是复杂的，有限的，主要来自美国，与大多数其他医疗保健系统相比，美国是一个局外人。在推动更多地使用市场机制的同时，来自其他方面的呼吁要求在医疗保健提供方面更多地整合，并对竞争能否带来所需的步骤变化表示怀疑。例如，目前在英国，有人强烈反对在联合政府的健康和社会保障法案中更多地使用市场力量。在美国，奥巴马的《平价医疗法案》包括加强医疗服务提供者和保险公司之间的整合。所有这些因素都意味着，了解市场力量在医疗保健领域的适用性和局限性是最重要的。我试图回答的最重要的问题是，在什么条件下，更多地使用市场机制将对医疗服务的使用者和付款人有利。在这个最重要的问题中，我将回答两个广泛的问题：在医疗保健中使用竞争和选择的支持力度有多大，以及有什么证据表明综合医疗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医疗工作的竞争；信息在提高质量方面的作用；选择家庭医生是否会提高他们的质量；生产应该集中在多大程度上；公立医院经理的薪酬结构是否奖励良好的业绩和良好的管理；非营利性医院在面临竞争时的表现如何？这些问题都是理解如何最好地提供医疗保健的核心问题。我们目前的了解是片面的，这限制了政策制定者寻找将提高卫生保健部门效率的解决方案。我的研究议程将与一个强有力的影响议程相结合，以翻译和传播这些以及其他学者的发现，为制定更好的政策提供信息。我在与政策制定者和行业参与者积极接触方面有着长期的记录：这种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影响。

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.