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首页> 外文期刊>Health economics, policy, and law. >Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?
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Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?

机译：提供者和医疗保健共同购买者的选择：英国国家卫生服务局可以从荷兰的改革中学习吗？

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摘要

In the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly 'internal market' models into their single-payer systems, to transform hierarchies into markets by separating 'purchasers' from 'providers', and enabling 'purchasers' to contract selectively with competing public and private providers so that 'money followed the patient'. This model has largely been abandoned where it has been tried. England, however, has implemented a modified 'internal market' model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.
机译：在1990年代，各国尝试了基于提供者和保险人选择的两种医疗保健改革模式。英国，意大利，瑞典和新西兰的政府将相对较快的“内部市场”模型引入其单一付款人系统，通过将“购买者”与“提供者”分开，并使“购买者”有选择地签约，从而将等级转换为市场与竞争激烈的公共和私人提供者合作，以便“金钱跟随病人”。该模型在尝试过的地方已被很大程度上抛弃。但是，英格兰实施了修改后的“内部市场”模型，强调患者的选择，迄今为止，该模型的结果令人失望。在荷兰，成功实施了由参保人在多家保险公司中进行选择的模型需要近20年的时间。但是到目前为止，这些保险公司仅部分意识到了与竞争提供商选择性签约的潜力。本文讨论了实施这些不同模型的困难以及英格兰和荷兰可以从中学到什么。作为一项思想实验，其中包括探索如何根据荷兰的经验将购买者的选择引入英国国家卫生服务局。

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