Analysing the transnational provisioning of services in the social sector: the case of commercialisation of NHS services in China and India

本研究解决了公共和私人组织在全球化商业医疗保健经济中定位英国的当代尝试。它询问了英国和两个被认为是潜在市场增长领域的主要“新兴经济体”（印度和中国）如何以及为什么要实现这一雄心壮志，并考虑了这三种情况下对公共或国有医疗保健、卫生培训组织和医疗保健用户的影响。该研究的目标是：1)描述和分析的关键驱动因素，参与者，市场和支持社会和政治基础设施的商业化跨国提供医疗保健；2)通过对英国-印度和英国-中国医疗保健提供的三个详细定性案例研究，在a)劳动力采购和流程，b)培训和管理咨询以及c)合资基础设施企业等领域调查这些及其日常运作和道德经济，以及3)考虑对三个国家医疗保健规划和治理的影响，并将其传达给学者、从业者、倡导和政策受众。本研究的背景是一个全球化时期，在这个时期，服务部门的组织方式以及公共服务的管理和提供方式发生了重大变化。在医疗保健领域，全球医疗保健行业的市场和投资机会日益扩大；医疗保健跨境消费增加，患者权益意识增强。在英国，对国民医疗服务体系（NHS）的结构进行了基于市场的累积改革，而中国和印度则进行了贸易政策改革，专科私立医院护理和相关诊断服务的增长，以及收费服务的扩大。随着英国“脱欧”退出欧盟，对招聘国际员工提出了新的需求，公共医疗机构正面临着“变得更具创业精神”以应对预算压力的压力。事实证明，中等收入国家的劳动力市场是卫生工作者的重要来源——由第三方商业机构或私营连锁医院提供——而中国和印度老龄化人口和中产阶级中非传染性疾病的负担日益加重，推动了对卫生保健服务的新需求，为英国的卫生保健组织，特别是医院、保险公司、专业团体和大学卫生学院。对于“NHS身份”来说，这似乎是一个重大的变化，营销已经开始着眼于向新受众提供离岸服务，主要是在这些新兴经济体。本项目旨在了解这些新的发展，这些发展反映了在商业化、劳动力市场和社会部门服务贸易方面更广泛的全球趋势。案例研究将包括后勤行政活动的跨国外包、培训和管理咨询以及医院发展的合资企业。它将探索英国、广东、福建和江苏（中国）以及德里、安得拉邦和马哈拉施特拉邦（印度）的组织之间的项目，检查“供给链”的所有要素，从治理和融资，到生产、提供/获得医疗设施和服务，以及消费。我们的研究结果对于提高公众对医疗保健经济日益全球化性质、正在促进的变化类型及其可能产生的影响这三种情况的认识和理解非常重要。我们的公共和政策参与活动旨在直接为医疗机构内部的政策制定提供信息，也可以通过与当地社区组织的参与间接提供信息。

This study addresses the contemporary attempts by public and private organisations to position the UK within a globalised commercial healthcare economy. It asks how and why this ambition is being realised in England and in two major 'emerging economies' perceived as potential areas of market growth (India and China), and considers the implications for public or state-owned healthcare, health training organisations and healthcare users in the three settings. The study objectives are to:1) describe and analyse the key drivers, actors, markets and supporting social and political infrastructures of commercialised transnational provisioning of healthcare; 2) investigate these and their everyday workings and moral economies through three detailed qualitative case studies of UK-India and UK-China healthcare provisioning in the areas of a) labour sourcing and processes, b) training and management consultancy and c) joint infrastructure ventures, and 3) consider the implications for healthcare planning and governance in the three countries, and communicate these to scholarly, practitioner, advocacy and policy audiences.The context for this research is a period of globalisation in which there have been significant changes in how service sectors are organised, and how public services are managed and provided. In the healthcare sector, there has been an increasing expansion of markets and of opportunities for investment in a global healthcare industry; greater cross-border consumption of healthcare, and increased consumer rights consciousness among patients. In England there have been cumulative market-based reforms to the structure of the National Health Service (NHS), while China and India have seen trade policy reforms, growth of specialist private hospital care and related diagnostic services, and expansion of fee-based provision.The run up to the UK's 'Brexit' departure from the European Union is posing new demands for recruitment of international staff, and public healthcare organisations are facing pressure to 'become more entrepreneurial' to cope with budgetary pressures. Labour markets in middle-income countries are proving a vital source of health workers - provisioned either by third-party commercial agencies or by private hospital chains - while the rising burden of non-communicable diseases amongst ageing and middle-class populations in China and India is driving new demand for healthcare services that offer potential new markets and sources of revenue for UK-based healthcare organisations, notably hospitals, insurance companies, professional bodies and university health schools. In what seems to be a significant step change for the 'NHS identity', marketing has begun with sights set on offshore provisioning to new audiences, primarily in these emerging economies. This project seeks to understand these new developments, which reflect wider global trends in commercialisation, labour markets and trade in social sector services. The case studies will include the transnational outsourcing of back-office administrative activities, training and management consultancies, and joint ventures for hospital development. It will explore projects between organisations in England and in Guangdong, Fujian and Jiangsu (China) and in Delhi, Andhra Pradesh and Maharashtra (India) examining all elements of the 'provisioning chain' from governance and financing, through to production, delivery of / access to healthcare facilities and services, and consumption.Our study findings will be important for raising public awareness and understanding in the three settings of the increasingly globalised nature of the healthcare economy, the types of changes being promoted, and their possible effects. Our public and policy engagement activities will aim to inform policy development within healthcare organisations directly, and also indirectly through engagement with local community organisations.