How much private sector in NHS?

英國的 NHS 現在是完全的公醫體系，但是現在保守黨執政的英國政府，打算將部分的醫院和組織私有化，並讓各地區的醫師團體有更多的權力分配醫療資源。半個世紀以來從來沒有私有化參與經驗的 NHS，面對各界對於私有化以後對於一般民眾醫療品質是否有影響的疑慮。想來台灣公私參半的全民健保可以經驗分享？還是給一點建議？

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1 June 2011 Last updated at 09:35
Article written by Robert Peston
Business editor

How much private sector in NHS?

I tried to set out the arguments for and against increasing the involvement of the private sector in the provision of NHS healthcare, in a short film for the Ten O'Clock News last night.

The central questions for me are these ones:

1) If you accept the argument that a bit of competition from the private and voluntary sector will help to spur productivity gains throughout the NHS (and not everyone does), what is the optimum share of NHS provision that the private sector should provide to deliver this benign outcome (right now, the private and voluntary sectors provide about 5% of NHS healthcare)?

1) 如果你接受私人部門和義工團體所帶來的一點競爭可以協助 NHS 增加生產力的論點，則 NHS 體系中應該有多少比例開放給私人部門，以達成此良好的結果 (目前私人部門和義工組織提供約 5% 的 NHS 醫療服務)？

2) Since there is evidence that competition is most effective at raising standards when weaker institutions, unable to raise their game, know that they will go bust, are we happy to see NHS hospitals put out of business? And if we are, can arrangements be put in place to minimise the disruption for patients and communities?

2) 既然證據顯示，因為虛弱的組織無法跟上而明白自己最終將會破產，競爭對於提升標準最為有效，我們是否樂於見到 NHS 醫院結束營業？且如果我們樂於見到此結果，是否已有安排以減少對病人和社區帶來的不便？

3) At what point (if ever) would the private sector's clout within the NHS be so great that private providers would be able to hold to ransom taxpayers who finance them (pay us more, or else), eroding the productivity gains? As we've seen with the financial crisis at the care home provider Southern Cross, the threat of an interruption of a vital service is quite a bargaining chip for a health provider.

3) 是否會在某個情況下，因為私人部門在 NHS 中巨大的影響力，私人醫療服務提供者因而得以勒索納稅人提供財務支持 (付更多錢或是其他方式)，而減少了所增加的生產力？正如我們在金融危機時見到安養院經營公司 Southern Cross，其終止提供重要服務之威脅是相當重要的議價工具。

4) And will the greater transparency of costs of different treatments and therapies likely to be brought by increased private sector involvement in the NHS start to undermine political and public support for the principle of universal provision that is free at the point of use? If it does, would that be a good thing or a bad thing?

4) 如增加私人部門參與 NHS，是否會因為不同治療的成本透明化，促使政治和公眾對於全面性免費提供醫療服務的支持減少？這是好還是壞？