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Competition in the NHS: a provider perspective

机译：NHS中的竞争：提供者的观点

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Objective: To analyse how competition is experienced and characterized by NHS and independent sector acute care providers in the English National Health Service (NHS). Methods: Semi-structured interviews with 49 senior staff in 15 NHS trusts and independent sector providers between November 2008 and April 2009, in England. Results: The market was predominantly defined based on geographical proximity. Competition was mainly on the periphery of catchment areas but markets were differentiated based on the scope and type of services. Niche providers, specialist hospitals and tertiary centres did not directly compete with district general hospital-type providers. Competitors were increasingly primary and community care providers, while there was little perceived threat from the private sector. There were many examples of how different providers (both NHS and independent sector) were co-operating and collaborating. Patients and general practitioners (GPs) appeared to be loyal to local providers. Conclusion: The providers' view of the market and the relevance of historical relationships and loyalties suggest fine grained variations in competition which is consistent with a relational rather than structural approach to competition. Also the evidence on embeddedness of relationships implies that collaboration might be a strong lever for quality improvement locally. Finally, some of the agreements found might be deemed in breach of the rules of competition but they may well be in the interests of patients and taxpayers, with implications for regulation in publicly funded health care systems.
机译：目的：分析英国国家卫生局（NHS）中的NHS和独立部门的急诊服务提供者如何体验和描述竞争。方法：2008年11月至2009年4月，在英格兰对15个NHS信托基金和独立部门提供者中的49名高级职员进行了半结构化访谈。结果：主要根据地理位置来确定市场。竞争主要集中在集水区的外围，但根据服务的范围和类型来区分市场。利基提供商，专科医院和三级中心没有直接与地区综合医院类型的提供商竞争。竞争对手越来越成为初级保健和社区护理的提供者，而私营部门几乎没有察觉到威胁。有许多例子说明了不同的提供者（NHS和独立部门）是如何合作和协作的。患者和全科医生（GPs）似乎忠于本地提供者。结论：提供商对市场的看法以及历史关系和忠诚度的相关性表明竞争中存在细微的差异，这与关系而非结构性竞争方法是一致的。同样，关于关系嵌入的证据表明，协作可能是提高本地质量的强大杠杆。最后，发现的某些协议可能被认为违反了竞争规则，但它们可能完全符合患者和纳税人的利益，对公共资助的医疗体系的监管产生了影响。

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