新西兰正在实行卫生事业组织和投资方面的重大改革,其中主要是设立经过广泛选举产生的地区卫生委员会。作者运用四种权力分散模式,即分权(行政上的)、放权(政策上的)、法人化(职能上的)及私有化(所有制上的),对这类变革进行了描述和分析。预计将有更多的权力从中央政府下放到地区卫生委员会,以扭转上一世纪业已出现的集权倾向。在地区卫生委员会内,正在实施体现上述分权模式的卫生服务管理双轨制,以取代目前社会事业性质的管理制度,并授予卫生专业人员、非政府性机构以及社区团体以更多的决策权。这些初步措施与以人口为基础对医院委员会所进行的投资相结合,并辅之以一系列服务计划准则。尤为重要的是,政府最近决定将初级卫生保健的投资和管理纳入地区卫生委员会权限范围。然而,实施统一的卫生制度需要专门的管理技能,因此,新西兰这些根本性改革是否能得到贯彻,人们甚为担忧。 New Zealand is implementing major reforms in the organization of health organizations and investments, which are mainly the establishment of regional health committees that have been widely elected. The author uses four modes of decentralization: decentralization (administrative), decentralization (policy), legalization (functional), and privatization (own ownership) to describe and analyze such changes. It is expected that more power will be delegated from the central government to the district health committees in order to reverse the trend of authoritarianism that has emerged in the past century. Within the District Health Committee, a dual-track system for health service management that embodies the above-mentioned decentralization model is being implemented to replace the management system of the current nature of social undertakings and to grant health professionals, non-governmental agencies and community groups more decision-making power. These preliminary measures are combined with a population-based investment in the Hospital Board, supplemented by a series of service planning guidelines. What is particularly important is that the government recently decided to include the investment and management of primary health care in the scope of the district health committee. However, the implementation of a unified health system requires specialized management skills. Therefore, it is very worrying whether these fundamental reforms in New Zealand can be implemented.