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本文运用结构式调查方法,探讨了澳大利亚、英国、德国、荷兰、挪威、瑞典和瑞士七个发达国家卫生系统的领导和治理情况。领导与治理模式包含三项基本职能:优先顺序设置、绩效监管和问责制。各国卫生系统的领导和治理方法存在着显著差异,零散并略显随意。虽然各国在卫生系统的总体目标上达成了共识,但设置优先顺序的途径各不相同。成本效益分析作为设置卫生系统运行优先顺序的一个主要方法被各国加以广泛运用,但并未发挥核心作用。各国虽然处于不同的发展阶段,但绩效监管却能广泛吸收有益意见。问责制特别是在最优方法的不确定性方面,各国之间的差异最大。大多数情况下,市场机制、选举程序、直接经济激励以及专业监督与控制等几种不同问责机制的组合可能更为合适。而且这些机制应与优先顺序设置和绩效监管协调一致。
Using structured surveys, this article explores the leadership and governance of the health system in seven developed countries in Australia, the United Kingdom, Germany, the Netherlands, Norway, Sweden and Switzerland. The leadership and governance model contains three basic functions: prioritization, performance monitoring and accountability. There are significant differences in leadership and governance approaches among health systems in different countries, fragmented and somewhat arbitrary. Although countries reached consensus on the overall goals of the health system, ways of prioritizing vary. Cost-benefit analysis, a major method of setting health system functioning priorities, is widely used by all but does not play a central role. Although countries are at different stages of development, performance monitoring can widely draw useful opinions. Accountability, especially in the uncertainty of the optimal method, varies the most among countries. In most cases, a combination of several different accountability mechanisms, such as market mechanisms, electoral processes, direct economic incentives and professional supervision and control, may be more appropriate. And these mechanisms should be coordinated with prioritization and performance monitoring.