从“预算式配置”到“战略性购买”:NHS英格兰医疗服务购买方式的改革、理论与绩效  

From Planned Budgeting to Strategic Purchasing:the Reform Theory and Performance of NHS England Health Service Contracting Approach

作　　者：李珍[1] 陈晋阳 Li Zhen;Chen Jinyang(School of Political Science and Public Administration,Wuhan University,Wuhan 430072;Centre for Health Economics,University of York,YorkYO105DD)

机构地区：[1]武汉大学政治与公共管理学院,武汉430072 [2]英国约克大学健康经济学中心,约克YO105DD

出　　处：《中国行政管理》2023年第11期115-124,共10页Chinese Public Administration

基　　金：世界银行贷款现代财政制度与国家治理技援子项目“基本医疗保险参保机制”(编号:2020K20071)。

摘　　要：本文研究了英格兰国家医疗服务体系(后文简称NHS英格兰)在医疗服务购买方式上的制度变迁史。本文发现,NHS英格兰自1948年建制以来经历了“预算式配置”“竞争性购买”和“战略性购买”三个阶段;经典行政管理理论、新公共管理理论和公共治理理论分别塑造了上述三个阶段的医疗服务购买方式;新公共管理理论塑造下的“竞争性购买”阶段虽然被寄予厚望,但是宏观健康绩效差强人意;作为对“竞争性购买”模式的纠正,NHS英格兰已于近年来完成了向“服务整合、供需协同”的“战略性购买”模式转型。通过比较分析,本文认为,中国不仅需要正确区分“集团购买”和“战略购买”并从“竞争性购买”模式中走出来,还要充分认识到我国基本医保支付政策赋能下的紧密型县域医共体建设正处于“战略性购买”政策实践的国际前沿。This paper studies the reform of health service contracting approach in the National Health Service England(NHS England).The paper finds that NHS England has gone through three phases of health service contracting,namely,'planned budgeting','competitive purchasing'and'strategic purchasing';classical public administrative theory,new public management theory and public governance theory shaped the health service contracting model in these phases separately;the'competitive purchasing'phase didn't reach a desirable performance,despite its high expectations;as a reaction to its poor performance,NHS England has recently completed its transition to an integrated care system.This paper argues that China needs to not only distinguish between'group purchasing'and'strategic purchasing'and move away from the'competitive purchasing'model,but also recognize that the construction of integrated health partnership at county level enabled by China's basic medical insurance payment policies might be at the forefront of international practice in'strategic purchasing'.

关 键 词：国家医疗服务体系 公共治理 医保战略购买 整合型健康服务体系 

分 类 号：D035[政治法律—政治学]