英國國民健康服務的發展(1948-1996)--臺灣全民健康保險的借鏡與啟示_

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題名：	英國國民健康服務的發展(1948-1996)--臺灣全民健康保險的借鏡與啟示
書刊名：	社會政策與社會工作學刊
作者：	黃源協
作者(外文)：	Hwang, Yuan-shie
出版日期：	1997
卷期：	1:1=1
頁次：	頁99-132
主題關鍵詞：	國民健康服務；總體經營；內部市場；National health service；General management；Internal market
原始連結：	連回原系統網址
相關次數：	被引用次數:期刊(6) 博士論文(0) 專書(2) 專書論文(0) 排除自我引用:6 共同引用:0 點閱:36

　　　　　NHS開辦後，第一次財政危機便接踵而來，五○年代年初期，兩大政黨皆曾採取部分負擔及總額預算方式應付之，保守黨政府更企圖要再折國到 NHI 的體系，唯因民眾對 NHS 的依賴與期待及社會主義團體的強烈反對，而使得此企圖未能得逞。受惠於戰後經濟的復甦與繁榮，六○年代及七○年代中期前，NHS 皆能在穩定中成長與發展。七○年代中期的石油危機，使得 NHS 面臨第二次的財政困境，保守黨於一九七九年執政後，經營效率的改善便被視為是舒緩財政壓力的主要策略，「總體經營」及「內部市場」的實施，即為實現此策略的具體措施。唯因前者缺乏市場的誘因及無法擺脫政治的影響，後者需大量的行政費用及 NHS 所強調的公平性遭受侵犯，而使得改革蒙上陰影。英國健康照護體系的發展，可提供臺灣全民健保多項重要的借鏡或啟示。就健康政策的制定而言，建康照護議題本是政治議題，讓「政治歸政治、醫療歸醫療」的理想，必難以達成，因而政策的制定應將政治現實視為重要變項。就財源籌措而言，健康照護財務自主的理想雖不易實現，但若能適時且斷然的採取有效策略加以防範，則健康照護的財務支出不必然會是個無底洞。就服務的經營而言，「公辦民營」雖可提昇效率，但若認為它能完全解決健康服務爭端及免除政府的責任，必是一廂情願的想法。

以文找文

　　　　　Shortly after the implementation of the NHS in 1948, to cope with its first financial crisis, various charges and global budget were introduced by both main parties. Furthermore, the Conservatives ever tried to convert the taxation-based health care system to a contributory one. The ambitious programme was finally abandoned as a result of its unpopularity and fierce opposition from the Labour Party. Benefited from the econonmic prosperity in the 1960s and early 1970s, the NHS's resources were increased steadily. However, the oil crisis of the mid-1970s brought the NHS into its second financial crisis. For coping with the difficulties, promoting efficiency has been regarded as one of main solutions by the Conservatives. `General management `and `internal market' have therefore been introduced and carried out. The former has not achieved its goals as expected partly due to absence of incentive and inability to get rid of political intervention, and the latter has suffered from serious condemnation as a result of the increase in management cost and the creation of a `two tier health service' There have been several lessons or implications for Taiwan's NHI First of all any health policy-makings should take political institutions in which they take place into consideration because health issues essentially are political issues. Secondly, health care expenditure does not necessarily mean a bottomless pit if proper measures could be implemented timely. Finally, even though privatisation is good for promoting efficiency, it does not mean or guarantee that government could be entirely exempted from the responsibility ofr health financing.

以文找文

期刊論文
1.	Game, Chris(1984)。'Axeman or Taxman': Who is Now More Unpopular?。Local Government Studies，10(1)，6-l1。
2.	Ham, Chris(1993)。How go the NHS Reform?。BMJ，306，77-78。
3.	Ham, Chris(1996)。Population-centred and patient-focused purchasing。Milbank Quarterly，74(2)，191-214。
4.	Ham, Chris(1996)。Contestability- a middle path for health care。British Medical Journal，213，70-71。
5.	Harrison, Anthony(1990)。Cost Containment in the NHS, 1979-1990。Policy Journal，77-95。
6.	Klein, Rudolf(1984)。The Politics of Ideology vs. the Reality of Politics: The Case of Britain's National Health Service in the 1980s。Milbank Quarterly，62(1)，83-109。
7.	Light, D. W.(1991)。Observations on the NHS Reforms: An American Perspective。British Medical Journal，303，568-570。
8.	Lowe, Rodney(1989)。Resignation at the Treasury: the Social Services Committee and the Failure to Reform the Welfare State, 1955-57。Journal of Social Policy，18(4)，505-526。
9.	Maynard, Alan(1987)。Is the NHS underfinanced?。The Health Service Journal，10，1048。
10.	Petchey, Roland(1993)。NHS Internal Market 1991-1992: Towards a Balance Sheet。British Medical Journal，306，699-701。
11.	Russell, William(1983)。On the Campaign Trail。British Medical Journal，280，1834。

研究報告
1.	KFI(1988)。Health Finance: Assessing the Options。London：KFL。
2.	Klein, Rudolf(1980)。Ideology, Class and the National Health Service。London：KFL。

圖書
1.	Abel-Smith, Brian、Titmuss, Richard M.(1956)。The Cost of the National Health Service in England and Wales。Cambridge：Cambridge University Press。
2.	Baggott, Rob(1994)。Health and Health Care in Britain。London：Macmillan。
3.	Beveridge, William(1942)。Social Insurance and Allied Services。London：Her Majesty's Stationery Office。
4.	Bulter, John、Vaile, Michael, S. B.(1984)。Health and Health Service: An Introduction to Health Care in Britain。London：Poutledge & Kegan Paul。
5.	Craig, F. W. S.(1990)。British General Election Manifesto, 1959-1987, Parliamentary Research Service。Aldershot：Dartmouth。
6.	DHSS(1983)。NHS Management Inquiry。
7.	DoH(1989)。White Paper; Working for Patien。London：HMSO。
8.	DoH(1994)。The Government's Expenditure Plans 1994-95 to 1996-97: Department Report。London：HMSO。
9.	Eckstein, Harry(1959)。The English Health Service: Its Origins, Structure, and Achievement。Oxford：Oxford University Press。
10.	Enthoven, Alain C.(1985)。Reflection on the Management of the National Health Service。London：Nuffield Provincial Hospital Trust。
11.	Michael, Foot(1975)。Aneurin BevanVol. 2:1945-1960。London：Davis-Poynten。
12.	Fowler, Norman(1991)。Ministers Decide: A Memoir of the Thatcher Years。London：Chapmans。
13.	Guillebaud, Claude W.(1956)。Report of the Committee of Enquiry into the Cost of the National Health Service。London：HMSO。
14.	Ham, Chris(1994)。Management and Competition。Oxford：Radical Medical Press。
15.	Judge, Ken(1990)。Health Policy in the Thatcher Era。London：KFI。
16.	Kember, T.、Macpherson, G.(1994)。The NHS- A Kaleidoscope of Care-Conflicts of Service and Business Value。London：The Nuffield Provincial Hospital Trust。
17.	Klein, Rudolf(1989)。The Politics of The NHS。London：Longman。
18.	Klein, Rudolf(1995)。The New Politics of The NHS。London：Longman。
19.	Fowler, Norman(1991)。Ministers Decide: A Memoir of the Thatcher Years。London：Chapmans。
20.	Labour Party(1958)。Report of the Annual Conference of the Labour Party。London：Labour Party。
21.	Labour Party(1994)。Health 2000- The health and wealth of the nation in the 21st century。London：Labour Party。
22.	Land, Andrew、Loew, Rodney、Whiteside, Noel(1992)。Development of the Welfare State 1939-51: A Guide to Documents in the Public Office。London：HMSO。
23.	Lowe, Rodney(1993)。The Welfare state in Britain Since 1945。London：Macmillan。
24.	OHE(1995)。Compendium of Health Statistics。London：OHE。
25.	O'Higgins, Michael(1987)。Health Spending: A Way of Sustainable Growth。London：Institute of Health Services Management。
26.	Raison, Timothy(1990)。Tories and Welfare State。London：Macmillan。
27.	RCNHS(1979)。Royal Commission on the National Health Service: Report。London：HMSO。
28.	Saltman, R.、Otter, C. V.(1992)。Planned Markets and Public Competition -- Strategic Reform in Northern European Health System。Buckingham：Open University Press。
29.	Seldon, Anthony(1981)。Churchill's Indian Summer: The Conservative Government, 1951-55。London：Hodder & Stoughton。
30.	TUC(1957)。Report of Annual Trades Union Congress。London：TUC。
31.	TUC(1961)。Report of Annual Trades Union Congress。London：TUC。
32.	Webster, Charles(1988)。The Health Services since the War: Problem of Health Care -- The NHS before 1957。London：HMSO。
33.	Williams, Philip M.(1979)。Hugh Gaitskell -- A Political Biography。London：Jonathan cape。
34.	Barr, Nichols、Glennerster, Howard、Le Grand, Julian(1988)。Reform and the National Health Service。London：Printer Publishers. Centre for Economics and Related Disciplines。

圖書論文
1.	Bosanquet, Nick(1992)。Interim Report: The National Health。British Social Attitudes: The 9th Report。Aldershot：Dartmouth。
2.	Forsyth, Gordon(1982)。The semantics of health policy and the inevitability of regulation。The Public/ Private Mix for Health。London：The Nuffield Provincial Hospital Trust。
3.	Ham, Chris(1995)。Managed Competition in Health Care。International Developments in Health Care: A Review of Health Care System in the 1990s。London：Loyal College of Physicians of London。
4.	Harvey, I.(1993)。And so to Bed: Access to Inpatient Services。Rationing and Rationality the National Health Service。London：Report Macmillan。
5.	Jones, Harriet(1991)。New Tricks for an Old Dog? The Conservatives and Social Policy。Contemporary British History 1931-61。London：Printer Publishing。
6.	Le Grand, Julian(1994)。Evaluating the NHS Reform。Evaluating the NHS Reforms。London：KFL。
7.	Le Grand, Julian. E.、Winter, D.、Wooley, Frances(1991)。The National Health Service: Safe in Whose Hands?。The State of Welfare -- The Welfare State in Britain since 1974。Oxford：Clarendon。
8.	Robert, Maxwell(1992)。International comparison of health expenditure。In the Best of Care?-- The status and future of health care in the UK。London：Chapman & Hall。
9.	Maynard, Alan(1989)。Yet another NHS Crisis?。Social Policy Review: 1988-89。London：Longman。
10.	Morgan, Myfanwy(1992)。Waiting Lists。In the Best of health Care?-- The status and future of health care in the UK。London：Chapman & Hall。
11.	Paton, Calum(1990)。The Prime Minister's Review of the NHS and the 1989 White Paper -- Working for Patients。Social Policy Review-- 1989-90。London：Longman。
12.	Ranade, Wendy、Haywood, Stuard C.(1991)。Privatising from Within: The National Health Service under Thatcher。Comparative Health Policy and New Right- From Rhetoric to Reality。London：Macmillan。
13.	Seale, John(1964)。Assumption of Health Service Finance。Trends in the National Health Service。Oxford：Pergamon Press。
14.	Smee, C. H.(1995)。Self-governing Trusts and GP funderholds: the British Experience。Implementing Planned Markets in Health Care-- Balancing Social and Economic Responsibility。Buckingham：Open University Press。
15.	Stocking, Barbara(1992)。The introduction of costs of new technologies。In The Best of Health Care? -- The status and future of health care in the UK。London：Chapman & Hall。
16.	Webster, Charles(1994)。Conservatives and Consensus: the Politics of the National Health Service, 1951-64。The Politics of the Welfare State。London：UCL Press。

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