On Administrative Governance In The National Health Service In The United Kingdom: From A Perspective Of Institutional History

After the Second World War, the U.K. built National Health Servicein1948to provide free healthcare service for the public with fundingfrom general tax. At the beginning, National Health Service adopted atripartite structure, with hospital service, general practice service andcommunity care service under different administration. As the result ofreorganization in1974, National Health Service developed a hierarchysystem, constructed by Ministry of Health, regional health authorities,and area health authorities, etc.. Health administrative sectors funded,owned and managed public hospitals, which applied internal measures ingovernance, such as planning, setting limitation on annual spending,reviewing on application for general practice, investigation andinspection.In1982, the government sought for simplification administrativestructures of National Health Service in order to decrease managementcost and increase efficiency of public funding, however, it failed to tackleserious financial crisis. In1990, the government turned to marketization reform, and began to construct internal market by functional separationfor purchasers and providers, with district health authorities and GPfund-holders as service purchasers, and NHS trusts as providers withrelative autonomy. In that phase, contractual governance was the maingovernance tool. Meanwhile, health authorities influenced conducts ofproviders by setting regulatory requirements, such as standards, guidanceand pricing rules. Auditing sectors and Health Service Commissionerssupervised purchasers and providers, and several non-departmentalbodies played partial regulatory functions by certification or othermeasures.During recent period, from1997to2010, the U.K. had introducedquality regulation in National Health Service, which provided qualityduty in legislation. New regulatory bodies in healthcare field, includingmonitor and The Healthcare Commission, were created, which regulatedpublic hospitals and private hospitals. Healthcare regulatory bodies setregulatory requirements, monitored compliance with those requirements,and guaranteed enforcement of those requirements by incentives,disciplinary actions and interventions.According to Health and Social Care Act2012, the governmentexerted radical reform in National Health Service. The main characteristicof that reform was decentralization of governance. In the healthcaregovernance network, government sectors and regulatory agencies undertook regulatory functions, professional regulatory bodies,commissioners, and boards of providers assumed regulatory functions,too. Regulatory tools became more various, which provided different toolsets for regulatory bodies to achieve regulatory targets.During Chinese healthcare reform, from the aspect of therelationship between rule of law and administrative reform, design ofhealthcare reform program should be prepared more sufficiently,participation for stakeholders in healthcare policymaking should bedeveloped, function of legislation in healthcare reform should bestrengthened, and organization system for healthcare reform should beperfected. From the aspect of construction of Chinese healthcaregovernance network, management functions of administrative authoritiesshould be reformed, relatively independent healthcare regulatory agenciesshould be built, reform of corporate governance structure should bepromoted, functions of self-regulatory bodies should be exerted, andwider public participation should be introduced. From the aspect ofregulatory measures, traditional regulatory tools should be improved andinnovative regulatory tools should be introduced to remedy shortcomingsof traditional enforcement.