Policymakers now have four decades’ experience using marketization to address cost and quality problems in public-sector health services. While much is known about the challenges, it is difficult to draw lessons because there remains no agreed-upon definition of marketization. This article contributes a definition that focuses on the transaction, particularly the effects of funding arrangements on the intensity of competition among providers. Based on prior literature and 106 interviews with practitioners and researchers in five countries, the authors contribute a systematization of 12 concrete market mechanisms enacting three market principles. Furthermore, the authors analyze respondents' perceptions of healthcare marketization's effects on costs and quality. While marketization is a multi-faceted, sometimes ambiguous phenomenon requiring further research before definite conclusions can be reached, most statements from our respondents about cost and quality effects were negative.

中文翻译：

---

公共医疗保健能负担得起市场化吗？五种卫生系统的市场原则、机制和影响

政策制定者现在拥有四个十年的使用市场化解决公共部门卫生服务成本和质量问题的经验。虽然人们对这些挑战了解很多，但很难吸取教训，因为市场化的定义仍然没有达成一致。本文提供了一个侧重于交易的定义，特别是资金安排对供应商之间竞争强度的影响。基于先前的文献和对五个国家的从业者和研究人员的 106 次采访，作者对制定三个市场原则的 12 种具体市场机制进行了系统化分析。此外，作者分析了受访者对医疗保健市场化对成本和质量影响的看法。虽然市场化是多方面的，