2015年经济学人 改革国民医保系统 良药苦口

Britain

Reforming the NHS

Bitter medicine

Competition is not the cause of the NHS's problems

LIKE patients shrinking from needles, many doctors fear politicians pushing market-oriented health policies.

For more than two decades governments of all shades have injected small doses of competition into England's publicly funded health system.

Reforms passed by the coalition¹ government in 2012 provided the most recent jab. They have left many people feeling queasy².

David Cameron, the prime minister, had hoped to see nearly all of the NHS's contracts awarded through competitive bidding.

In the end, his new rules acknowledged that non-competitive contracting is sometimes the best choice if the process is transparent³, unbiased, and clearly benefits patients.

But the local groups responsible for purchasing care (known as Clinical Commissioning Groups, or CCGs)

complain that they have received mixed messages. Some of the doctors that run CCGs say they fear legal challenges from health providers if they do not tender all of their contracts competitively.

In February Andy Burnham, the shadow health secretary, said CCGs had spent 5m ($8.4m) on competition lawyers during the previous year.

Sir David Nicholson, former head of the NHS, said that the service is “bogged down in a morass⁴ of competition law”.

The health regulator, Monitor, tacitly concedes that the rules could be clearer.

It is busy tutoring CCGs on what they actually mean.

If they honour common sense and put patients' interests first “they're 95% there”,

says Andrew Taylor, former head of the NHS's Co-operation and Competition panel.

And CCGs are probably wrong to believe that the coalition's most recent reforms will mean their decisions get challenged more often through the courts.

In truth, health providers have been growing more combative⁵ for years.

In 2011 the Royal Brompton hospital in London went to court in the hope of reversing a plan to consolidate⁶ paediatric heart surgery in other hospitals.

(It lost, but the case had a “signalling effect”, says Mr Taylor.)

In fact by beefing up Monitor's role, the government's reforms have provided a means of resolving disputes outside the courts.

The reforms will probably have a bigger effect on hospital mergers⁷.

The government made it clear that the Competition Act—which prohibits anti-competitive agreements and the abuse of a dominant⁸ market position—should be applied⁹ to the NHS.

In October two cash-strapped hospitals in Dorset were blocked from joining up on the grounds that it would give patients too few choices.

This was controversial because the hospitals argued that their agreement would result in better care, a difficult thing to gauge¹⁰.

Some doubt the competition authorities can get the cost-benefit analysis right.

David Bennett of Monitor believes some of the hand-wringers are more interested in ending, not improving, the current competition regime.

Mr Burnham admits as much, but his options are limited even if Labour wins the next election.

His proposal to favour NHS hospitals and clinics for contracts may turn out to be illegal under European law.

The NHS's new boss, Simon Stevens, seems keen on competition. Patients will benefit if he can convince critics of its merits.

Two studies at English hospitals found that competition saved lives without increasing costs.

Another study showed that family doctors located close to rival practices performed better. The medicine is working. Time to increase the dosage.

1 coalition   

n.结合体，同盟，结合，联合

参考例句：

• The several parties formed a coalition.这几个政党组成了政治联盟。
• Coalition forces take great care to avoid civilian casualties.联盟军队竭尽全力避免造成平民伤亡。

2 queasy   

adj.易呕的

参考例句：

• I felt a little queasy on the ship.我在船上觉得有点晕眩想呕吐。
• He was very prone to seasickness and already felt queasy.他快晕船了，已经感到恶心了。

3 transparent   

adj.明显的，无疑的；透明的

参考例句：

• The water is so transparent that we can see the fishes swimming.水清澈透明，可以看到鱼儿游来游去。
• The window glass is transparent.窗玻璃是透明的。

4 morass   

n.沼泽，困境

参考例句：

• I tried to drag myself out of the morass of despair.我试图从绝望的困境中走出来。
• Mathematical knowledge was certain and offered a secure foothold in a morass.数学知识是确定无疑的,它给人们在沼泽地上提供了一个稳妥的立足点。

5 combative   

adj.好战的；好斗的

参考例句：

• Mr. Obama has recently adopted a more combative tone.奥巴马总统近来采取了一种更有战斗性的语调。
• She believes that women are at least as combative as are.她相信女性至少和男性一样好斗。

6 consolidate   

v.使加固，使加强；(把...)联为一体，合并

参考例句：

• The two banks will consolidate in July next year. 这两家银行明年7月将合并。
• The government hoped to consolidate ten states to form three new ones.政府希望把十个州合并成三个新的州。

7 mergers   

n.（两个公司的）合并( merger的名词复数 )

参考例句：

• Mergers fall into three categories: horizontal, vertical, and conglomerate. 合并分为以下三种：横向合并，纵向合并和混合合并。 来自辞典例句
• Many recent mergers are concentrated within specific industries, particularly in retailing, airlines and communications. 现代许多合并企业集中进行某些特定业务，在零售业、民航和通讯业中更是如此。 来自英汉非文学 - 政府文件

8 dominant   

adj.支配的，统治的；占优势的；显性的；n.主因，要素，主要的人(或物)；显性基因

参考例句：

• The British were formerly dominant in India.英国人从前统治印度。
• She was a dominant figure in the French film industry.她在法国电影界是个举足轻重的人物。

9 applied   

adj.应用的；v.应用，适用

参考例句：

• She plans to take a course in applied linguistics.她打算学习应用语言学课程。
• This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。

10 gauge   

v.精确计量；估计；n.标准度量；计量器

参考例句：

• Can you gauge what her reaction is likely to be?你能揣测她的反应可能是什么吗？
• It's difficult to gauge one's character.要判断一个人的品格是很困难的。