贝维里奇系统中的综合护理:英格兰和丹麦的经验
Apostolos Tsiachristas1, Karsten Vrangbæk2, Pamela Gongora-Salazar3
1Nuffield Department of Primary Care Health Sciences and Department of Psychiatry, University of Oxford, Oxford, UK.
英国和丹麦都进行了卫生系统改革,引入了选择和竞争. 尽管采取了不同的方法,但两国最终建立了跨部门的治理结构,以改善综合护理.
科学领域:
- 医疗服务研究 医疗服务研究
- 比较的健康政策比较健康政策
- 医疗保健系统的整合
背景情况:
- 国际卫生系统面临着越来越多的压力,需要协调和综合提供护理.
- 卫生系统的碎片化受到融资和交付模式的影响,但不仅仅由它们解释.
研究的目的:
- 为了比较30年来在英国和丹麦推动护理整合的政策和改革.
- 通过使用SELFIE框架,分析两个Beveridge式卫生系统的综合护理途径.
主要方法:
- 对英格兰和丹麦的卫生系统改革进行比较分析.
- 应用SELFIE框架来评估护理整合政策.
- 三十年来改革轨迹的检查.
主要成果:
- 两国都启动了选择和竞争的改革,但走上了不同的道路.
- 20年后,改革导致了类似的结构,强调跨部门治理.
- 英国引入了分散的综合护理系统;丹麦实施了集中化的健康集群.
结论:
- 针对选择和竞争的改革可以矛盾地导致综合护理结构.
- 跨部门治理是实现在可比卫生系统中实现综合护理的关键成果.
- 分散式和集中式的方法可以通过治理改革来促进综合护理.
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