背景:尽管西方政府对新公共管理(NPM)的原则及其刺激“医疗保健企业家精神”的能力充满信心,目前尚不清楚寻求改革医疗服务的政策如何在提供长期医疗服务的个体机构中激发这种企业家精神。这项研究检查了荷兰养老院中患有痴呆症(如阿尔茨海默病)的老年人的这种状况反应。
方法:进行了为期四年的归纳纵向单案例研究。在此期间,荷兰政府实施了各种基于NPM的医疗改革,这项研究考察了当地的反应如何在疗养院中展开。通过与经理进行的访谈,管理员和支持人员,以及对大量政府指示和内部文件的审查,这篇论文记录了这些改革是如何产生几种类型的企业家精神的,这并不都有利于政府渴望的医疗保健创新。
结果:该研究记录了在地方层面部署的三个后续策略:取消医疗保健服务;与邻近机构的非医疗保健相关合作;以及在特定医疗保健领域的专业化。这些策略是由特定类型的企业家精神带来的,其中两种是针对行政组织而不是医疗保健创新。该研究讨论了在地方一级进行多种创业变化的含义。
结论:医疗改革的政府政策可能更有效,如果政策制定者改变以产出为基础的筹资系统,认识到长期医疗保健提供者对客户精神疾病和最终转嫁的进展控制有限。
BACKGROUND: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate \"healthcare entrepreneurship\", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer\'s disease.
METHODS: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have.
RESULTS: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship - two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level.
CONCLUSIONS: Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients\' mental disease and ultimate passing.