⺰  ᢥࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿㧦
ᚻᴺ⛔৻ᕈߣේଔ⸘▚⋙ᩏߩᒝൻ⨹ ੗   ⠹*ᄢ㒋Ꮢ┙ᄢቇᄢቇ㒮⚻༡ቇ⎇ⓥ⑼ഥᢎ᝼ 㧝㧚ߪߓ߼ߦ
ࠗࠡ࡝ࠬක≮⇇㧔NHS㧕ߢߪ㧘᡽ᐭߩਥዉߦࠃࠅฎߊ߆ࠄේଔ⸘▚ᵴേ߇ขࠅ⚵߹ࠇ㧘90 ᐕઍߦߪේ
ଔ⸘▚߇ᕆㅦߦ᥉෸ߒߡ޿ߞߚ‫⸻ߚ߹ޕ‬ᢿ⟲ಽ㘃㧔HRG㧕೎ේଔ⸘▚ߦ㑐ߒߡ߽㧘97 ᐕߩෳᾖේଔ೙ᐲ
ዉ౉એ㒠㧘ᕆㅦߦ᥉෸࡮ᵞ✵ൻߐࠇߡ߈ߡ޿ࠆ‫ߚߒ߁ߎޕ‬㐳ᐕߩ NHS ේଔ⸘▚ߩข⚵ߺ߇㧘࿖ቯଔᩰߦ
ࠃࠆᵴേ㊂ߦᔕߓߚታ❣ᛄ޿೙ᐲ㧔PbR: Payment by Results㧕ߣ޿߁ᣂߒ޿⾗㊄ଏ⛎ࠪࠬ࠹ࡓߩዉ౉ࠍ
น⢻ߥ⁁ᴫߦߒߡ޿ࠆ‫ ࠄߥߗߥޕ‬PbR ߢߪ㧘HRG ߏߣߩో࿖ᐔဋේଔࠍࡌ࡯ࠬߦฦ HRG ߩ࿖ቯଔᩰ෸
߮⋧ኻ࠙ࠛࠗ࠻߇⸳ቯߐࠇ㧘ߘࠇࠍ↪޿ߡᡰᛄ޿߇ߥߐࠇࠆ઀⚵ߺߢ޽ࠆߚ߼㧘ฦ∛㒮ߢߩ HRG ೎ේଔ⸘▚ߩታᣉ߇೨ឭߣߥࠆ߆ࠄߢ޽ࠆ‫ޕ‬৻ᣇ㧘ߎߩᣂߒ޿⾗㊄ଏ⛎೙ᐲߩዉ౉߇ේଔ⸘▚ᣇᴺ╬ߦዋߥߊߥ޿ᓇ㗀ࠍਈ߃ߟߟ޽ࠆ‫ޕ‬PbR ೙ᐲߩᧄᩰㆇ↪ߦะߌߡ㧘ේଔ⸘▚ኻ⽎ߣߒߡߩ HRG ߩౣ⸳⸘߿㧘ේଔ⸘▚ኻ⽎ߢ޽ࠆ HRG ߩන૏ᢙ᷹ቯᴺ
ߩᄌᦝ㧘ේଔ⸘▚ࡊࡠ࠮ࠬߩᡷༀߣ∛㒮㑆ߩᚻᴺ⛔৻ߩᒝൻ߇ㅴ߼ࠄࠇߡ޿ࠆઁ㧘ઍᦧ⊛ߥේଔ⸘▚೙ᐲߩน⢻ᕈߩᬌ⸛߿ේଔ⸘▚⋙ᩏߩᧄᩰൻ߽ᬌ⸛ߐࠇߡ޿ࠆ‫ޕ‬ᧄ⺰ᢥߢߪ㧘
NHS ේଔ⸘▚ߣߎߩࠃ߁ߦኒធߥ㑐ଥߦ޽ࠆ PbR ೙ᐲߦߟ޿ߡ߹ߕ⚫੺ߔࠆ‫ޕ‬ߘߩ਄ߢ㧘
PbR ߩᧄᩰㆇ↪ߦਇนᰳߥ NHS ේଔ⸘▚ߩ⃻⁁ߦߟ޿ߡ㧘ᒰ੐⠪ߢ޽ࠆ଻ஜ⋭ߩ⹺⼂ߣ╙ਃ⠪ߢ޽ࠆ
Audit Commission ߩ⺞ᩏ⚿ᨐ࡮⷗⸃ߣ޿߁ 2 㕙߆ࠄ⼏⺰ߔࠆ‫ ߡߒߘޕ‬PbR ߦኻᔕߔࠆߚ߼ߩ NHS ේଔ⸘▚ߩᣂዷ㐿࡮ឭ᩺ߦߟ޿ߡᬌ⸛ߔࠆ‫ౕޕ‬૕⊛ߦߪ㧘ේଔ⸘▚ኻ⽎ߢ޽ࠆ HRG ߩౣ⸳⸘ߣߘߩන૏ᢙ᷹
ቯᴺߩᄌᦝ㧘⛔৻ᕈᒝൻࠍ⁓ߞߚᮡḰൻߐࠇߚ࿖ኅේଔ⸘▚࠰ࡈ࠻෸߮⽶ᜂシᷫࠍ⁓ߞߚઍᦧ⊛ේଔ⸘▚೙ᐲߩᬌ⸛㧘ේଔ⸘▚⋙ᩏߩᒝൻ࡮౏ᑼൻߦߟ޿ߡ⺰ㅀߔࠆ‫ޕ‬

㧞㧚Payment by Results ೙ᐲዉ౉ߩ⢛᥊ߣ೙ᐲ᭎ⷐ
2.1. PbR ೙ᐲዉ౉ߩ⢛᥊ᖚ⠪߇ࠃࠅ୘೎⊛ߢᯏേ⊛ߥක≮ࠨ࡯ࡆࠬࠍฃߌࠄࠇࠆࠃ߁ߦ㧘ක≮ឭଏࠪࠬ࠹ࡓࠍᄌᦝߔࠆᔅⷐ߇޽
ࠅ㧘ߘߩߚ߼ߦ 10 ᐕ⸘↹ߢ޽ࠆ NHS ࡊ࡜ࡦߣߘߩࡆ࡚ࠫࡦߩ㆐ᚑߩߚ߼ߩ৻ㅪߩᡷ㕟ࡊࡠࠣ࡜ࡓ߇╷ቯ* 1971 ᐕ↢߹ࠇ‫ޕ‬1994 ᐕ৻ᯅᄢቇ໡ቇㇱතᬺ‫ޕ‬ን჻✚ว⎇ⓥᚲࠍ⚻ߡ㧘৻ᯅᄢቇᄢቇ㒮ୃੌ㧔໡ቇඳ჻㧕‫ޕ‬ᄢ㒋Ꮢ┙ᄢቇᄢቇ㒮⚻༡ቇ⎇ⓥ⑼ኾછ⻠Ꮷࠍ⚻ߡ㧘2002 ᐕࠃࠅ⃻⡯‫ޕ‬ක≮ᣉ⸳⚻༡቟ቯൻផㅴ੐ᬺ⎇ⓥળ㧘࿖┙∛㒮╬⽷ോળ⸘࡮▤ℂળ⸘ࠪࠬ࠹ࡓ╬ᬌ⸛ળ㧘‫ޟ‬ᕆᕈᦼ౉㒮ක≮⹜ⴕ⸻ᢿ⟲ಽ㘃ࠍᵴ↪ߒߚ⺞ᩏ⎇ⓥ‫ޠ‬ක≮⚻ᷣ⃰㧘‫ޟ‬㐿⸳ਥ૕೎∛㒮ળ⸘Ḱೣㆡ↪ߦ㑐ߔࠆ⺞ᩏ࡮⎇ⓥ‫⎇ޠ‬ⓥදജ⠪ળ⼏࡮ኾ㐷ኅળ⼏㧘‫ޟ‬ක≮ᯏ㑐ߩㇱ㐷೎෼ᡰߦ㑐ߔࠆ⺞ᩏ⎇ⓥ‫ޠ‬ᬌ⸛ᆔຬળߥߤ㧘ᄙᢙߩෘ↢ഭ௛⋭ߩᬌ⸛ળ╬ߩᆔຬࠍോ߼ߡ߈ߚ‫ߚ߹ޕ‬㧘ᘮᙥ⟵Ⴖᄢቇකቇㇱ㧘᧲੩ක⑼ᱤ⑼ᄢቇᄢቇ㒮ߢ⻠Ꮷࠍോ߼ߡ߈ߚ‫ޕ‬ਥߥ⺰ᢥ࡮⪺ᦠߦ㧘‫ޟ‬ක≮ಽ㊁ߦ߅ߌࠆ▤ℂળ⸘ߩዷ㐿㧙⑳ડᬺ▤ℂળ⸘ߩᵴ↪㧙‫ޠ‬‫ޡ‬ળ⸘‫ޢ‬163㧔5㧕㧘‫ޡ‬ක≮ࡃ࡜ࡦࠬ࠻࡮ࠬࠦࠕࠞ࡯࠼‫ޢ‬㧔ਛᄩ⚻ᷣ␠㧘2005 ᐕ㧕ߥߤ߇޽ࠆ‫ޕ‬ㅪ⛊వ㧦arai@bus.osaka-cu.ac.jp㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕ߐࠇߚ‫ޕ‬NHS ߪ㧘ਛᄩ᡽ᐭߦࠃࠅㆇ༡ߐࠇߚක≮ࠨ࡯ࡆࠬߩ⁛භ⊛ឭଏ⠪߆ࠄ㧘⁛┙ᯏ㑐ߦࠃࠅㅘ᣿ߢ
౒ㅢߩၮḰߦᾖࠄߒߡᬌᩏ࡮ⷙ೙ࠍฃߌߟߟ㧘ᖚ⠪ߦኻߒߡࠃࠅᄙ᭽ߢᄙర⊛ߥࠨ࡯ࡆࠬࠍឭଏߔࠆਥ૕
߳ߣᄌ㕟ߐࠇࠆ‫ޕ‬NHS ࡊ࡜ࡦߩࡆ࡚ࠫࡦߪ㧘ᖚ⠪ࠍࡄ࡯࠻࠽࡯ߣߒߡᛒ޿㧘ㄦㅦ߆ߟଢ೑ߢ㜞ຠ⾰ߥࠨ࡯ࡆࠬࠍឭଏߔࠆߎߣߢ޽ࠆ߇㧘ߘࠇߪᰴߩ 4 ὐߩ౏⊛࠮ࠢ࠲࡯ᡷ㕟ߦ߅ߌࠆ᡽ᐭߩේೣᨒ⚵ߺߦၮߠ޿
ߡ޿ࠆ㧔DH, 2003b㧕‫ޕ‬Ԙ ࿖ኅ࡟ࡌ࡞ߩ㜞޿᳓Ḱߣ᣿⏕ߥࠕࠞ࠙ࡦ࠲ࡆ࡝࠹ࠖԙ ᜛ᄢߐࠇߚ࿾ᣇ࡟ࡌ࡞ߢߩਥዉߣࠗࡁࡌ࡯࡚ࠪࡦԚ ⃻႐ࠬ࠲࠶ࡈ߳ߩ᜛ᄢߐࠇߚᨵエᕈԛ ࠃࠅᄙ᭽ߥឭଏᣇᴺߦᡰ߃ࠄࠇߚᖚ⠪ߩㆬᛯ⢇ߩ᜛ᄢ৻ᰴ⸻≮ᯏ㑐߿∛㒮ߪ㧘࿾ၞ૑᳃ߦኻߒߡක≮ࠍឭଏߔࠆᦨ⦟ߩᣇᴺࠍᮨ⚝ߔࠆ⥄↱߇ਈ߃ࠄࠇ㧘ߎࠇࠍᡰ߃ࠆߚ߼ߩၮḰ෸߮ࠕࠞ࠙ࡦ࠲ࡆ࡝࠹ࠖߩ࿖ኅᨒ⚵ߺ߽᭴▽ߐࠇࠆ‫ޕ‬࿖ኅၮḰߪ NSF㧔National
Service Frameworks㧕ߣ NICE㧔National Institute for Clinical Excellence㧕ߦࠃࠅ⸳ቯߐࠇ㧘ࠃࠅᄙߊߩᖱႎߣࠃࠅ᜛ᄢߐࠇߚࠕࠞ࠙ࡦ࠲ࡆ࡝࠹ࠖ߇ᖚ⠪෸߮࿖᳃ߦኻߒߡߥߐࠇࠆ‫ޕ‬ක≮ߩᨵエߥᆔ⸤ࠪࠬ࠹
ࡓߪ㧘ක≮࠾࡯࠭⹏ଔߣ㧘⛔วߐࠇߚࠤࠕࡄࠬߦၮߠ޿ߚ⥃ᐥࡀ࠶࠻ࡢ࡯ࠢߦࠃࠆᖱႎߦᡰ߃ࠄࠇߚ㧘ᖚ⠪ㆬᛯߦၮߠߊో૕⊛⸘↹ߦࠃߞߡਥዉߐࠇࠆᔅⷐ߇޽ࠆ㧔DH, 2002㧕‫࡮↹⸘ߚߒ߁ߎߡߒߘޕ‬ᆔ⸤ᵴേߪ㧘ᆔ⸤⠪ߢ޽ࠆ৻ᰴ⸻≮ᯏ㑐ߣฃ⸤⠪ߢ޽ࠆක≮ឭଏ⠪(∛㒮ઁ)ߣߩലᨐ⊛࡮㐿᡼⊛࡮දജ⊛࡮㐳ᦼ⊛ߥ㑐ଥߩ߽ߣߢߥߐࠇࠆᔅⷐ߇޽ࠅ㧘ࠨ࡯ࡆࠬౣ᭴▽ߩද௛㧘ࠤࠕࡄࠬ߿⚫੺࡮࡝ࠬࠢ▤ℂߦߟ޿ߡߩ౒
᦭ߐࠇߚขࠅ᳿߼߇㕖Ᏹߦ㊀ⷐߦߥࠆ㧔DH, 2002㧕‫ޕ‬ߎ߁ߒߚᡷ㕟ߪ 2003 ᐕᐲ߆ࠄ 5 ᐕ㑆ߦࠊߚࠆ NHS ߳ߩᐕᰴᐔဋ 7.4㧑߽ߩ⾗㊄Ⴧടࠍ઻޿ߟߟታⴕߐ
ࠇߡ߅ࠅ㧘ߔߢߦ⾰ᡷༀ߿ᓙᯏᦼ㑆ߩ❗ዊߥߤߩ৻ቯߩㅴዷࠍ↢ߺ಴ߒߟߟ޽ࠆ㧔DH, 2003b㧕‫ߣޕ‬หᤨߦ
ߎߩ⾗㊄Ⴧടߪ㧘ᖚ⠪෸߮࿖᳃ߦኻߒߡ⸽᣿น⢻ߥᒻߢ⚿ᨐࠍታ⃻ߔࠆ⽿છࠍ NHS ߦኻߒߡ߽ߚࠄߒߡ
޿ࠆ㧔DH, 2002㧕‫ޕ‬߹ߚᖚ⠪ߩߚ߼ߦࠃࠅ୘೎⊛ߥࠨ࡯ࡆࠬࠍឭଏߢ߈ࠆߚ߼ߦߪ㧘౒ㅢߩ࿖ኅᮡḰߦ⷗วߞߚࠨ࡯ࡆࠬࠍ
ឭଏߔࠆࠃࠅᐢ▸࿐ߩឭଏᯏ㑐 1)ߩᡰេߩਅߢ㧘ᖚ⠪ߦኻߒߡࠃࠅᯏേ⊛ߢലᨐ⊛ߥࠨ࡯ࡆࠬࠍ৻ᰴ⸻≮ᯏ㑐߇ᆔ⸤ߔࠆߣߣ߽ߦ㧘ߎ߁ߒߚ⋡⊛ࠍᡰ߃ࠆߚ߼ߩ⾗㊄ଏ⛎ࠪࠬ࠹ࡓߩᄌ㕟߇ᔅⷐߢ޽ࠆ‫ࠬࠪߩߘޕ‬࠹ࡓߪ㧘NHS ߳ߩ⾗㊄Ⴧടߦࠃࠆᖚ⠪߳ߩଢ⋉ࠍᦨᄢൻߐߖࠆ߽ߩߢߥߌࠇ߫ߥࠄߕ㧘ᰴߩࠃ߁ߥⷐઙ
߇ᔅⷐߣߐࠇࠆ㧔DH, 2002㧕‫ޕ‬Ԙ 㔛ⷐߣ࡝ࠬࠢࠍ▤ℂߒߟߟ㧘ឭଏࠨ࡯ࡆࠬߦኻߒߡ౏ᱜ߆ߟㅘ᣿ߦᡰᛄࠊࠇࠆ 2)ԙ ᖚ⠪߇ㆬᛯߒߚᣉ⸳ߦ⏕ታߦ⾗㊄߇ଏ⛎ߐࠇࠆࠃ߁ߦߒ㧘ᖚ⠪ㆬᛯ೙ᐲࠍᡰេߔࠆԚ ࠨ࡯ࡆࠬឭଏߩല₸ᕈߣ⾰ߦႎ޿ࠆԛ ฃ౉ᘒ൓ࠍ㔛ⷐߦ⷗วߞߚ࡟ࡌ࡞ߦߔࠆߎߣࠍᡰេߔࠆԜ ଔᩰࠍᎼࠆ⺰੎߆ࠄ㧘࿾ၞ૑᳃ߩ࠾࡯࠭෸߮ᖚ⠪߳ߩࠤࠕࡄࠬߦኻᔕߒߚࠨ࡯ࡆࠬߩ㊂ߣ⒳㘃
ߦߟ޿ߡߩ⼏⺰߳㧘ὶὐߩౣォ឵ࠍଦߔ 3)1) ߎࠇࠄߩឭଏᯏ㑐ߪ㧘ၮḰߦ⷗วߞߡ޿ࠆ߆ߤ߁߆ߦߟ޿ߡ㧘CHAI㧔Commission for Healthcare Audit and Inspection㧕ߦࠃࠆ⁛┙⋙ᩏࠍฃߌࠆ‫ޕ‬2) ㆊᐕᐲ੍▚ߦਥߣߒߡଐሽߒ㧘߹ߚฦ⚻༡▤ℂ⠪ߩ੤ᷤᛛⴚߦଐሽߒߚ∛㒮߳ߩ⾗㊄ଏ⛎ߢߪߥߊ㧘౏ᱜߢ৻⽾ᕈߩ޽ࠆ⾗㊄ଏ⛎ࠍ⏕ታߦߔࠆࠪࠬ࠹ࡓߣ߽ㅀߴࠄࠇߡ޿ࠆ㧔Website of DH: Introduction to Payment by Results㧕‫ޕ‬3) ߎߩⷐઙߩ⢛᥊ߦߪ㧘90 ᐕઍߩౝㇱᏒ႐ߩዉ౉ߦࠃࠆ৻ᰴ⸻≮ᯏ㑐ߣ∛㒮ߣߩଔᩰࠍᎼࠆ⺰੎߇㧘⛔ว⊛ࠤࠕ࡮⥃ᐥࠕ࠙࠻ࠞࡓ࡮ේଔല₸ᕈ࡮ᖚ⠪૕㛎࡮ឭଏ౏ᐔᕈߩะ਄ߦߣߞߡ㊀ⷐߥක≮ᯏ㑐ߩᨒࠍ⿥߃ߚ⥃ᐥࡀ࠶࠻ࡢ࡯ࠢ㧔DH, 2002㧕ࠍᖡൻߐߖߚߣ޿߁ᛕ್࡮෻⋭߇޽ࠆ‫ޕ‬߹ߚ᡽ᐭߪ㧘
‫ޟ‬ᢇᕆᖚ⠪ߪㆬᛯߩ૛࿾ߥߊᦨ߽ㄭ޿ᕆᕈᦼ∛㒮ࠍ೑↪ߔࠆߒ㧘㕖ᢇᕆߩ႐ว߽ߚ޿ߡ޿ߩᖚ⠪ߪㄭߊߩ∛㒮ࠍ೑↪ߔࠆߎߣࠍᅢ
߻ߩߢ㧘ଔᩰ┹੎ߪ∛㒮ࠨ࡯ࡆࠬߦ߅޿ߡߪ৻⥸⊛ߦ᦭ലߢߪߥ޿ߣ⹺⼂ߒߡ޿ࠆ㧔DH, 2002, p.13㧕
‫ߣޠ‬ㅀߴ㧘ଔᩰߢߩ⺰੎ߪ᦭ലߢߥ޿ߩ
ߢ㧘ଔᩰߦߟ޿ߡߪ৻ᓞߩ࿖ቯଔᩰࠍㆡ↪ߔࠆߣߒߡ޿ࠆ‫ޕ‬㧙㧙

ࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿

2.2. PbR ೙ᐲߩ᭎ⷐ
એ਄ߩࠃ߁ߥⷐઙࠍḩߚߔ⾗㊄ଏ⛎ࠪࠬ࠹ࡓߣߒߡ㧘ෳᾖේଔ೙ᐲ਄ߩ HRG ᐔဋේଔࠍࡌ࡯ࠬߣߒߚ
HRG ࿖ቯଔᩰࠍᵴ↪ߒߡ㧘ታ㓙ߩឭଏᵴേ㊂ߦᔕߓߡᡰᛄ߁⾗㊄ଏ⛎೙ᐲߢ޽ࠆ PbR ߇㧘Ბ㓏⊛ߦዉ౉ߐࠇࠆߎߣߣߥߞߚ‫ᤨޕ‬㑆ࠍ߆ߌߡᲑ㓏⊛ߦዉ౉ߔࠆߩߪ㧘ല₸ᕈߩ㆑޿ߛߌߢߥߊ㧘HRG ಽ㘃ߩਇቢోߐ߿ෳᾖේଔ೙ᐲ਄ߩ࠺࡯࠲ߩ໧㗴㧔㕖⛔৻⊛ᚻᴺߦࠃࠆේଔ⸘▚ߥߤ㧕߆ࠄ㧘߹ߛ∛㒮㑆ߩේଔߩࡃ
࡜࠷ࠠ߇⪺ߒߊᄢ߈޿㗔ၞ߇޽ࠆ߆ࠄߢ޽ࠆ‫∛ߚ߹ޕ‬㒮㑆ߩේଔߩ㆑޿߇⪺ߒߊᄢ߈޿ߚ߼㧘ߔߋߦዉ౉
ߔࠆߣ∛㒮ߣᆔ⸤⠪ߩ⽷ോ⁁ᴫ߇ᕆߦਇ቟ቯߦߥࠆ࡝ࠬࠢ߇޽ࠆߎߣ߿㧘ᐔဋේଔએਅߢ⃻࿷ឭଏߒߡ޿
ࠆ࿾ၞ㧔∛㒮㧕ߦ߅ߌࠆᆔ⸤⠪ߩଢ⋉ߣឭଏ⠪ߩଢ⋉ߣߩࡃ࡜ࡦࠬࠍ⠨ᘦߔࠆᔅⷐ߇޽ࠆߎߣߥߤ߆ࠄߢ
޽ࠆ㧔DH, 2002㧕
‫ޕ‬
2003 ᐕᐲߦߪ㧘߹ߕ㧘࿖ኅ⋡ᮡߩ㆐ᚑߦߣߞߡ㕖Ᏹߦ㊀ⷐߥ 15 ⒳㘃ߩ HRG ߦߟ޿ߡߪ㧘2002 ᐕᐲ
ឭଏ㊂ 4)ࠍ⿥߃ࠆᵴേ㊂ߦኻߒߡෳᾖේଔ೙ᐲߦࠃࠆᐔဋේଔࠍࡌ࡯ࠬߣߒߚ࿖ቯන૏ଔᩰߢ⾗㊄ଏ⛎
㧔ਅ࿁ࠆᵴേ㊂ߦኻߒߡ࿖ቯන૏ଔᩰߢ⾗㊄࿁෼㧕߇ߥߐࠇࠆ‫ ߩઁߩߘߚ߹ޕ‬HRG ߩ߁ߜ㧘6 ߟߩᄖ⑼♽⸻≮⑼ߦ㑐ଥߔࠆㇱಽߦߟ޿ߡߪ㧘ෳᾖේଔ೙ᐲߩᐔဋේଔࠍࡌ࡯ࠬߣߒߚ⋧ኻଔ୯න૏㧔╬ଔଥᢙ㧕ߦࠃࠆࠤ࡯ࠬࡒ࠶ࠢࠬ⺞ᢛࠍߒߚᵴേ㊂ߦኻߒߡ㧘੍ቯឭଏ㊂ࠍ⿥߃ࠆᵴേ㊂ಽߦ࿾ၞ⁛⥄ߩන૏ଔᩰࠍ
ㆡ↪ߒߡㅊടߩ⾗㊄ଏ⛎
㧔੍ቯឭଏ㊂ࠍਅ࿁ࠆᵴേ㊂ಽߦ⁛⥄න૏ଔᩰࠍㆡ↪ߒߡ⾗㊄࿁෼㧕߇ߥߐࠇࠆ‫ޕ‬
੍ቯឭଏ㊂߿㧘⸻≮⑼ࡌ࡯ࠬߢߩࠤ࡯ࠬࡒ࠶ࠢࠬ⺞ᢛᓟᵴേ㊂ߦኻߔࠆᒰ㕙ߩ⁛⥄න૏ଔᩰߦߟ޿ߡߪ㧘ឭଏ᳓Ḱวᗧᦠ㧔Service Level Agreement㧕ߦࠃࠅฦ࿾ၞߩਥ૕㑆ߢ᳿ቯߔࠆ‫ߚ߹ޕ‬࿖ቯන૏ଔᩰߩ⸳ቯ
ߦ㓙ߒߡߪ㧘࿾ၞߦࠃࠆੱઙ⾌╬ߩ㆑޿ࠍ෻ᤋߐߖߚ⺞ᢛ߿ᣂᛛⴚዉ౉ࠦࠬ࠻߿ࠗࡦࡈ࡟ߩ⺞ᢛߥߤ߇ߥ
ߐࠇࠆઁ㧘ᭂ┵ߦ㜞޿߆ૐ޿ේଔߩ଀ᄖᛒ޿ߥߤ߽ߥߐࠇࠆ‫߅ߥޕ‬ឭଏ᳓Ḱวᗧᦠߦၮߠߊߎߩ⾗㊄ଏ⛎
ࠪࠬ࠹ࡓߦࠃࠅ㧘ឭଏᵴേ㊂ߦ㑐ଥߥߊ৻ቯ㗵߇ᡰᛄࠊࠇࠆᓥ᧪ߩ Block ᄾ⚂ 5)߆ࠄ㧘ឭଏᵴേ㊂ߣࠤ࡯ࠬࡒ࠶ࠢࠬࠍ෻ᤋߒߚ㧔࡝ࠬࠢ▤ℂࠍߒߚ㧕Cost and Volume ᄾ⚂ߦ⒖ⴕߔࠆߎߣߦߥࠆ‫ޕ‬
2004 ᐕᐲߦߪ㧘ߐࠄߦ 33 ⒳㘃ߩ HRG㧔ว⸘ 48 ⒳㘃㧕߇࿖ቯන૏ଔᩰߦࠃࠅ୘೎⊛ߦ⾗㊄ଏ⛎ߐࠇࠆߎߣߦߥࠅ㧘߹ߚࠤ࡯ࠬࡒ࠶ࠢࠬ⺞ᢛᓟ Cost and Volume ᄾ⚂ߦࠃࠆ⸻≮⑼࡟ࡌ࡞ߩ⾗㊄ଏ⛎ᣇᴺ߽ోߡߩᄖ⑼♽⸻≮⑼ߣᄢㇱಽߩౝ⑼♽⸻≮⑼ߦㆡ↪ߐࠇࠆ‫ ߦࠄߐޕ‬2005 ᐕᐲ߆ࠄߪ㧘ߔߴߡߩ⸻≮⑼߇ࠤ࡯
ࠬࡒ࠶ࠢࠬ⺞ᢛᓟ Cost and Volume ᄾ⚂ߢ⾗㊄ଏ⛎ߐࠇࠆߣߣ߽ߦ㧘3 ᐕ㑆߆ߌߡ⁛⥄න૏ଔᩰ߆ࠄ࿖ቯ
න૏ଔᩰߦࠃࠆఘㆶߦᲑ㓏⊛ߦ⒖ⴕߔࠆ‫ᧄ߅ߥޕ‬ᩰ⊛ߥ⒖ⴕ߇ᆎ߹ࠆ 2005 ᐕᐲߩ઀⚵ߺ߇ Foundation∛㒮 6)ߦኻߒߡߪᦨೋ߆ࠄㆡ↪ߐࠇ㧘Foundation ∛㒮ߩ╙৻㒯߇⺀↢ߒߚߩߪ 2004 ᐕ 4 ᦬ߢ޽ࠆߚ߼㧘ߎࠇࠄߩ∛㒮ߦኻߒߡߪ 2004 ᐕᐲ߆ࠄᧄᩰ⒖ⴕ߇ᆎ߹ߞߡ޿ࠆ‫ޕ‬
ߎߩ PbR ೙ᐲߪߔߴߡߩ౉㒮࡮ᣣᏫᴦ≮㧘ᄖ᧪㧘੐᡿࡮ᢇᕆ㧘♖␹ක≮㧘৻ᰴ⸻≮ߥߤࠍኻ⽎ߣߒߚ߽ߩ߳ߣ▸࿐ࠍ᜛ᄢߒߡ޿ߊ੍ቯߢ޽ࠆ 7)‫ߒ߆ߒޕ‬ᣢߦ⹦⚦ߥᵴേ㊂࡮ේଔ⸘▚ᖱႎࠍ෼㓸ߒߡ޿ࠆ㗔ၞߦᒰ㕙ߪ㒢ቯߖߑࠆࠍᓧߥ޿ߚ߼㧘߹ߕ 2005 ᐕᐲߪ㧘ᄖ᧪㧘㊀◊㧘੐᡿࡮ᢇᕆࠍ฽߼ࠆࠃ߁ߦ᜛ᄢߔࠆߎ
ߣߣߐࠇߚ㧔DH, 2003b㧕
‫ߒ߆ߒޕ‬㧘PbR ⒖ⴕ߳ߩ⽷ോ⊛቟ቯᕈࠍ⏕଻ߔࠆߚ߼ߦ㧘࿾ၞߢวᗧߐࠇߚଔ
ᩰߣ࿖ቯଔᩰߣߩᏅ⇣ࠍ⺞ᩏߒߚߣߎࠈ㧘✕ᕆ౉㒮ᖚ⠪߿ᄖ᧪ᖚ⠪ߢߪ࿖ቯଔᩰߩା㗬ᕈ߇ૐ޿ߎߣ߇್
᣿ߒߚߚ߼㧘ታ㓙ߦߪ㧘ߔߢߦㆡ↪ߐࠇߡ޿ࠆ Foundation ∛㒮એᄖߢߪ㧘2005 ᐕᐲߪㆬᛯ౉㒮ᖚ⠪ߩߺ4) 2002 ᐕᐲឭଏ㊂ಽߪฦ࿾ၞߩਥ૕㑆ߢቯ߼ߚ⁛⥄න૏ଔᩰߢ⾗㊄ଏ⛎ߐࠇࠆ‫ޕ‬5) ਥߣߒߡㆊ෰ߩ⾗㊄ଏ⛎ᣇᴺ࡮㊂ߣฦ࿾ၞਥ૕㑆ߢ੤ᷤߐࠇߚᐕᰴჇട㗵ߦၮߠߊᄾ⚂ߢ޽ࠆ‫੍ߪߢߎߎޕ‬ቯߐࠇߡ޿ߚᵴേ㊂ߣ⇣ߥࠆ႐วߩ࡝ࠬࠢ▤ℂᣇᴺ߇᣿⏕ߦߐࠇߡ޿ߥ޿‫ޕ‬6) ෳᾖේଔ೙ᐲߢ㜞޿ല₸ᕈߣ᦭ലᕈࠍ㆐ᚑߒߚఝ⦟∛㒮ߦኻߒߡਈ߃ࠄࠇࠆ࿾૏ߢ޽ࠅ㧘ฦ∛㒮⁛⥄ߩⵙ㊂ᮭ߇᏷ᐢߊਈ߃ࠄࠇߡ޿ࠆ‫ޕ‬7) ߘߩ㓙㧘ᒰ㕙ߪᄖ᧪↪ߩ࿖ቯଔᩰ߇⸳ቯߐࠇࠆ߇㧘㐳ᦼ⊛ߦߪ㧘౉㒮࡮ᣣᏫᴦ≮࡮ᄖ᧪ߣ޿ߞߚឭଏ႐ᚲߩ㆑޿ߢߪߥߊ㧘ߤߩࠃ߁ߥ⸻≮߇ߥߐࠇߚ߆ߦߩߺၮߠ޿ߚන৻ߩ࿖ቯଔᩰࠍ⸳ቯߔࠆߎߣ߇⋡ᮡߣߐࠇߡ߅ࠅ㧘⃻ᤨὐߢ߽౉㒮ߣᣣᏫᴦ≮ߪหߓ࿖ቯଔᩰߢ޽ࠆ‫ߒߛߚޕ‬✕ᕆ౉㒮ߣㆬᛯ౉㒮ߣߢߪ⾗Ḯᶖ⾌㊂߇⇣ߥࠆߚ߼㧘೎‫ߩޘ‬࿖ቯଔᩰ߇⸳ቯߐࠇߡ޿ࠆ‫ޕ‬㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕ࠍኻ⽎ߣߔࠆߎߣߦߥߞߚ㧔DH, 2005a㧕‫ߦ߁ࠃߩߎޕ‬⒖ⴕࡊࡠ࠮ࠬߪㆃࠇߟߟ޽ࠆ߇㧘2008 ᐕᐲ߹ߢߦ
∛㒮ක≮ߩᄢㇱಽࠍ࿖ቯଔᩰߦၮߠߊ PbR ߢఘㆶߔࠆߣ޿߁ో૕ߩ࠲ࠗࡓ࠹࡯ࡉ࡞ߪᄌᦝߐࠇߡ߅ࠄߕ
㧔DH, 2005a㧕㧘∛㒮ߢߪ 2005 ᐕᐲએ㒠 25㧑㧘50㧑㧘75㧑ߣ࿖ቯଔᩰߩഀวࠍ㜞߼ߡ޿߈㧘2008 ᐕᐲ߆ࠄߪ 100㧑࿖ቯଔᩰࠍㆡ↪ߔࠆ੍ቯߢ޽ࠆ㧔DH, 2005b㧕
‫ޕ‬ߥ߅ Foundation ∛㒮ߢߪ 2004 ᐕᐲ߆ࠄ޿ߊߟ߆ߩ⸻≮⑼ߩᄖ᧪߽ PbR ߩኻ⽎ߣߒߚ߇㧘ኻ⽎ߣߒߚᄖ᧪⸻≮⑼ߪේଔ⸘▚ᖱႎߩ⾰ߦ଻ஜ⋭߇ᦨ߽⥄ାߩ޽ࠆ⸻≮⑼ߢ޽ࠅ㧘∛㒮㑆ߢේଔߩࡃ࡜࠷ࠠ߇ዋߥ
޿⸻≮⑼ߢ޽ࠆ㧔DH, 2004㧕‫ ߽ߦߎߎޕ‬PbR ೙ᐲ߇޿߆ߦේଔ⸘▚ߦᷓߊଐሽߒߡ޿ࠆ߆߇⴫ࠇߡ޿ࠆ‫ޕ‬ߘߩߚ߼଻ஜ⋭߽㧘
‫ޟ‬NHS ో૕ߣߒߡේଔ⸘▚ߩ⾰ߣ⛔৻ᕈߩ޽ࠆ⒟ᐲߩᡷༀߪ⷗ࠄࠇߡ߈ߚ߇㧘ోᵴേ㗔ၞߦࠊߚࠆ PbR ࠍᡰ߃ࠆ߶ߤචಽߥ⾰ߪ߹ߛߥ޿ߣᐢߊ⹺⼂ߐࠇߡ޿ࠆ㧔DH, 2003b, p.5㧕‫߼⹺ߣޠ‬㧘‫∛ޟ‬㒮㑆ߢห৻ߩ⚻༡᧦ઙࠍ⏕଻ߔࠆߚ߼㧘ේଔ⸘▚࡮ಽ㘃ᣇᴺߩࠃࠅߒߞ߆ࠅߣߒߚⷙቯࠍዉ౉ߔࠆߎ
ߣࠍឭ᩺ߔࠆ㧔p.5㧕‫ߣޠ‬ㅀߴ㧘ේଔ⸘▚ᣇᴺߩߐࠄߥࠆ⛔৻ൻࠍਥᒛߒߡ޿ࠆ‫ޕ‬
PbR ೙ᐲਅߢߪේଔ⸘▚⚿ᨐ߇⾗㊄ଏ⛎೙ᐲߦ૶ࠊࠇࠆߚ߼ߦ㧘޿߹߹ߢએ਄ߦᚻᴺߩ⛔৻ൻ߇ᔅⷐߣ
ਥᒛߐࠇߡ޿ࠆ㧔DH, 2003b㧕
‫᧪ᧄߒ߆ߒޕ‬㧘ᚻᴺߩ⛔৻ൻߪᓥ᧪ߩࡌࡦ࠴ࡑ࡯ࠢਛᔃᤨઍߦ߅޿ߡ߽ᒝߊ
ᔅⷐߣߐࠇࠆ߽ߩߢ޽ࠅ㧔⨹੗, 2006a,b㧕㧘࿖ቯଔᩰ⸳ቯ⋡⊛ਛᔃᤨઍߛ߆ࠄߎߘߣ޿߁ߎߣߪߥ޿‫⏕ޕ‬߆ߦ㧘ේଔ⸘▚ߩఘㆶ⋡⊛ߢߩ૶↪ߪ෼౉ߦ⋥⚿ߔࠆߚ߼㧘ฦ∛㒮߇ේଔ⸘▚ߦኻߒߡ㕖Ᏹߦᢅᗵߦߥࠅ㧘ߘࠇࠁ߃∛㒮㑆ߩᣇᴺߩ⛔৻ᕈ߇ᒝߊ᳞߼ࠄࠇࠆߩߪℂ⸃ߢ߈ࠆ‫ߒ߆ߒޕ‬㧘ᧄ᧪ߢ޽ࠇ߫㧘޿߹߹ߢߩⶄ
ᢙ∛㒮㑆ߩේଔᲧセ࡮ࡌࡦ࠴ࡑ࡯ࠢߩᣇ߇߽ߞߣᚻᴺ㑆ߩ⛔৻ᕈ߇㊀ⷐߢ޽ࠆ‫∛ోޕ‬㒮ߩᐔဋේଔࠍࡌ࡯
ࠬߣߒߚ࿖ቯଔᩰ⸳ቯߩ႐ว㧘⛔৻ᕈߩᄙዋߩᰳᅤࠍේ࿃ߣߔࠆ∛㒮㑆ߩේଔߩᄙዋߩ㆑޿ߪ㧘ᐔဋൻߔࠆߚ߼ߦߘࠇ߶ߤᄢ߈ߥᓇ㗀ࠍ෸߷ߐߥ޿ߪߕߢ޽ࠆ߆ࠄߢ޽ࠆ‫ޕ‬
߹ߚ PbR એ೨ߦ߽㧘ᐔဋේଔࠍࡌ࡯ࠬߣߒߚ∛㒮㑆ߩᲧセ࡮ᬺ❣⹏ଔߣߘߩఝ⑲ᕈߣ⚿߮ߟ޿ߚⵙ㊂ᮭ
ߩᄢ᏷ߥ⒖⼑ߣ޿߁᡽╷ߪขࠄࠇߡ߈ߡ߅ࠅ㧘‫ޟ‬ᐔဋේଔ‫ߩޠ‬᡽╷਄ߩᵴ↪ߣ޿߁ⷰὐ߆ࠄ߽㧘චಽߦ⛔৻
ᕈߩ㊀ⷐᕈߪ޿߹߹ߢ߽޽ߞߚ‫৻⛔ࠆߥࠄߐޕ‬ൻߩᔅⷐᕈߪ㧘੹߹ߢ⛔৻ᕈ߇ਇචಽߛߞߚߎߣߩ⴫ࠇߢ
޽ࠆ‫ޕ‬߻ߒࠈߎߩᤨઍߦߥߞߡ․ߦ㊀ⷐߦߥߞߡ߈ߚߩߪ㧘ᧄᒰߦᵴേ෸߮ේଔ࠺࡯࠲߇ㆡಾߦಣℂߐࠇ㧘⛔৻⊛ߥᣇᴺߦḰ᜚ߒߡේଔ⸘▚߇ታᣉߐࠇߡ޿ࠆߩ߆㧘ߦ㑐ߔࠆḰ᜚ା㗬ᕈߩ⏕଻ߢ޽ࠅ㧘ߘࠇࠁ߃ේ
ଔ⸘▚⋙ᩏߩᧄᩰൻ࡮ᒝൻߢ޽ࠈ߁‫ޕ‬ߎ߁ߒߚ⾗㊄ଏ⛎ࠪࠬ࠹ࡓߩᡷ㕟ߦࠃࠅ㧘ឭଏࠨ࡯ࡆࠬߦኻߔࠆ৻⽾ߒߚㅘ᣿ߥᡰᛄ޿ࠍㅢߓߡ 8)ឭଏ㊂᜛ᄢߩേᯏࠍਈ߃ߟߟ㧘ᐔဋේଔࠍ↪޿ࠆߎߣߢ 9)∛㒮㑆ߩේଔ࡮ല₸ᕈߩࡃ࡜࠷ࠠࠍዋߥߊߒ㧘߹ߚᣂߚߥઍᦧ⊛ឭଏਥ૕޽ࠆ޿ߪᣇᴺ߳ߩ⾗㊄ᓴⅣࠍኈᤃߦߔࠆߎߣ߇ߢ߈ࠆߣߒߡ޿ࠆ‫ߩߎߚ߹ޕ‬ᡷ㕟ߦࠃࠅ㧘ଔᩰ߳ߩ⏕ା߇㜞߹ࠆߚ߼ߦਛᦼ⸘↹߇┙ߡ߿ߔߊߥࠆߒ㧘⾗㊄ߩ૶޿㆏ࠍ࿖᳃ߦ⺑᣿ߒ㧘‫⾗ޟ‬㊄ߦ
⷗วߞߚଔ୯‫ࠍޠ‬ឭଏߒߡ޿ࠆ߆ߣߩ໧޿ߦ╵߃ࠆߎߣࠍኈᤃߦߔࠆ㧔DH, 2002㧕‫ޕ‬ߥ߅ᢎ⢒࡮⎇ⓥ㐿⊒⾌↪ߦߟ޿ߡ߽㧘PbR ߩዉ౉ߦᴪ߁ᒻߢ㧘ᢎ⢒࡮⎇ⓥ㐿⊒੍▚߇㈩ಽߐࠇࠆࠃ߁ߦ㧘੍▚೙ᐲࠍ⷗⋥ߔᔅⷐ߇޽ࠆߣߒߡ޿ࠆ‫⚻ߩᤨޕ‬ㆊߦࠃࠆ⁁ᴫߩᄌൻߩ⚿ᨐߣߒߡ㧘ᢎ⢒ᵴേ߿⎇ⓥ㐿⊒ᵴേ߆ࠄ↢ߓࠆㅊട⊛⾌↪ߦኻߔࠆᢎ⢒੍▚߿⎇ⓥ㐿⊒⾗㊄߇୘‫∛ߩޘ‬㒮ߦㆡಾߦ⵬ఘߐࠇߡ޿ߥ޿㧘ߣ8) PbR ߩਅߢߪ৻⽾ߒߚㅘ᣿ߥᡰᛄ޿(ଔᩰઃߌ)߇น⢻ߦߥࠆ߇㧘⾼౉⠪ߦࠃࠆ∛㒮ߩ⾰ࠍ⠨ᘦߒߚଔᩰ੤ᷤߣ޿߁ᓥ᧪޽ߞߚᨵエᕈ߇ᄬࠊࠇ
ࠆߎߣߦߥࠆߚ߼㧘૗ࠄ߆ߩᣇᴺߢឭଏ㊂ࠍ⾰޽ࠆ޿ߪࠕࠢ࠮ࠬߦᔕߓߡ⺞ᢛߔࠆ߆㧘⾰ะ਄ߦ㑐ㅪߔࠆේଔߩ඙ಽᛠីߣෳᾖේଔ⸘▚߆ࠄߩ㒰ᄖ㧘߇ᔅⷐߢ޽ࠆߣߩᜰ៰߇⷗ࠄࠇࠆ㧔Street and AbdualHussain, 2004, p.306㧕
‫ޕ‬9) ޿ߊߟ߆ߩ HRG ߦߟ޿ߡߪ㧘ᐔဋේଔ߇ਛ㑆୯(㗅⇟߇ߜࠂ߁ߤ⌀ࠎਛߩ∛㒮ߩේଔ)ࠃࠅ߽ߒ߫ߒ߫߆ߥࠅᄢ߈ߊ㧘ෳᾖේଔ࠺࡯࠲ߩಽᏓ
߇ᱡࠎߢ޿ࠆߚ߼㧘ᐔဋේଔߦၮߠ޿ߡ࿖ቯଔᩰࠍ⸳ቯߔࠆߎߣߪਇㆡಾߢ޽ࠆߣߩᛕ್߽⷗ࠄࠇࠆ㧔Street and AbdualHussain, 2004, p.
305㧕
‫৻ߚ߹ޕ‬ᰴ⸻≮߿ࠦࡒࡘ࠾࠹ࠖࠤࠕᡰេߩᢛ஻߇ਇචಽߥ࿾ၞߩ∛㒮ߪ㧘ࠃࠅ㐳޿ᦼ㑆ᖚ⠪ࠍ౉㒮ߐߖߡ߅ߊᔅⷐ߇޽ࠆߚ߼ߦේଔ߇㜞ߊߟߊ߆߽ߒࠇߕ㧘࿾ၞ੐ᖱࠍ⠨ᘦߒߚ⺞ᢛ߇ᐔဋේଔߦၮߠߊ࿖ቯଔᩰߦᔅⷐߢ޽ࠆߣ߽ᜰ៰ߐࠇߡ޿ࠆ㧔p.306㧕
‫∛ߦࠄߐޕ‬ᐥⷙᮨߩ㆑޿
߿ឭଏࠨ࡯ࡆࠬࡒ࠶ࠢࠬߩ㆑޿ߦ㑐ㅪߔࠆේଔߪ㧘ዋߥߊߣ߽⍴ᦼ⊛ߦߪ∛㒮ߦߣߞߡߪ㒢ቯߐࠇߚ▤ℂߒ߆ߢ߈ߥ޿ߚ߼㧘ߘߩᓇ㗀߽⺞ᢛߔߴ߈ߣ߽ᜰ៰ߐࠇߡ޿ࠆ㧔p.306㧕‫ޕ‬㧙㧙

ࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿޿߁ ᔨ߇⷗ࠄࠇࠆߎߣࠍ଻ஜ⋭ߪ⹺⼂ߒߡ޿ࠆ‫ޕ‬ᢎ⢒࡮⎇ⓥ㐿⊒੍▚ߩᄌ㕟ߪኈᤃߥࡊࡠ࠮ࠬߢߪߥ޿
ߎߣߣ㧘૞ᬺ㊂ߣᱜ⏕ᕈߩⷰὐ߆ࠄ㧘⹦⚦ߥࡏ࠻ࡓࠕ࠶ࡊේଔ⸘▚ࠕࡊࡠ࡯࠴ 10)ߣ࠻࠶ࡊ࠳࠙ࡦේଔ⸘▚ࠕࡊࡠ࡯࠴ߩ㑆ߩࡃ࡜ࡦࠬ߇ᔅⷐߦߥࠆߣ⹺⼂ߒߡ޿ࠆߣㅀߴߡ޿ࠆࠃ߁ߦ㧔DH, 2003a㧕㧘ᢎ⢒⾌࡮⎇ⓥ㐿⊒⾌ߩฦ∛㒮߳ߩㆡಾߥ㈩ಽߦ߽ේଔ⸘▚ࠍᵴ↪ߔࠆߎߣࠍ᣿⏕ߦߒߡ޿ࠆ‫ޕ‬㧟㧚NHS ේଔ⸘▚ߩ⃻⁁
3.1. ଻ஜ⋭ߩ⹺⼂ෳᾖේଔ⸘▚࠺࡯࠲ߩ⾰ߪ޽ࠆ⒟ᐲߩᡷༀ߇ߥߐࠇߡ߈ߚߚ߼㧘ᕆᕈᦼ∛㒮ߩේଔߩࡃ࡜࠷ࠠߪᷫዋߒ
ߡ߈ߚ‫⽾৻ࠅࠃޕ‬ᕈߩ޽ࠆ෩ᩰߥේଔ㈩⾮ᣇᴺ߇೑↪ߐࠇࠇ߫㧘ߎߩ௑ะ߇⛯ߊߣᦼᓙߐࠇࠆߒ㧘㕖ᕆᕈᦼ㗔ၞߦ߅޿ߡ߽ห᭽ߩᡷༀ߇ᦼᓙߐࠇࠆ‫ߛߚޕ‬ᄙߊߩ⸻≮ࠨ࡯ࡆࠬߦ߅޿ߡ㧘ႎ๔ߐࠇߚේଔߦߥ߅⺑᣿ߩߟ߆ߥ޿ࡃ࡜࠷ࠠ߇޽ࠆߚ߼㧘ේଔ⸘▚ߣᵴേ⸥㍳߇ᡷༀߐࠇߥߌࠇ߫ߥࠄߥ޿ߣ⹺⼂ߒߡ޿ࠆ‫ߣޕ‬ࠅࠊߌ㧘޿ߊߟ߆ߩ∛㒮ߦ߅޿ߡ㧘⸻≮⑼ߩ․ቯߩ⸻≮ࠨ࡯ࡆࠬߦ㈩ಽߐࠇߥ޿ᵴേ㊂㧔ේଔ㧕߇ሽ࿷ߔࠆߎߣ߇᳇߇߆ࠅߢ޽ࠅ㧘㈩ಽߐࠇߥ߆ߞߚᵴേߩේଔߪઁߩႎ๔ߐࠇߚᵴേ߳ߣഀࠅᒰߡࠄࠇߡ޿ࠆߎ
ߣߦߥࠆ߇㧘ߎ߁ߒߚ⁁ᴫߪ࿖ቯଔᩰ⸳ቯߩߚ߼ߩᜬ⛯น⢻ߥ㐳ᦼ⊛⁁ᴫߢߪߥ޿ߣᜰ៰ߒߡ޿ࠆ㧔DH,
2003b㧕
‫ޕ‬߹ߚ‫ޟ‬Payment by Results ߪ㧘ේଔ⸘▚ࠪࠬ࠹ࡓߣේଔ⸘▚ᖱႎߩ⾰ࠍߒ߫ߒ߫഍⊛ߦᡷༀߔࠆᱜ߆
ߟ⌀ߩࠗࡦ࠮ࡦ࠹ࠖࡉࠍ߽ߚࠄߔߢ޽ࠈ߁㧔DH, 2003b, p.41㧕
‫߽ߣޠ‬ㅀߴߡ޿ࠆ‫ ߦ߆ߒߚޕ‬PbR ೙ᐲߩዉ౉ߦࠃࠅ㧘ේଔ⸘▚ߩ⾰ࠍᡷༀߒߥߌࠇ߫ฦ∛㒮ߪㆡಾߦ⽷ോ࡮ේଔ▤ℂߦขࠅ⚵߻ߎߣ߇ߢ߈ߕ㧘⽷ോ⊛ߥ࡝ࠬࠢ߇㜞߹ࠆ‫߼ߚߩߘޕ‬ฦ∛㒮ߪ⥄ࠄߩ⚻༡▤ℂ⋡⊛ߩߚ߼ߦේଔ⸘▚ߩ⾰ࠍ㜞߼ࠆേᯏ߇޽ࠆ‫ޕ‬᡽ᐭߦࠃࠆᒝ೙⊛ߥႎ๔ߩߚ߼ߩේଔ⸘▚㧔એਅ㧘ႎ๔ේଔ⸘▚ߣ๭߱㧕ߩዉ౉࡮⾰ะ਄╷߇හല⊛ߥലᨐࠍ߽ߚࠄߔߩߦኻߒߡ㧘⚻༡▤ℂ⋡⊛ࠍ⢛᥊ߣߒߚේଔ⸘▚ߩዉ౉࡮⾰ะ਄േᯏߪߓࠊߓࠊߣ㐳ᦼ⊛ߦലᨐࠍ߽ߚࠄߔߩߢ㧘㐳ᦼ⊛ߦߪේଔ⸘▚ߩ⾰ะ਄߳ߣߟߥ߇ߞߡ޿ߊน⢻ᕈߪ㜞޿‫߽߆ߒޕ‬ႎ๔ේଔ⸘
▚߇ฦ∛㒮ߦࠃࠆᠲ૞ߩኻ⽎ߣߥࠅ߿ߔ޿ߩߦኻߒߡ㧘⚻༡▤ℂ⋡⊛ࠍਥߚࠆ⢛᥊ߣߒߚේଔ⸘▚ߪߘ߁ߒߚᠲ૞ߩࠗࡦ࠮ࡦ࠹ࠖࡉ߇ૐ޿‫⚻ߒߛߚޕ‬༡▤ℂ⋡⊛߆ࠄ⾰ߩ㜞޿ේଔᖱႎߩ࠾࡯࠭߇ฦ∛㒮ߦߣߞߡ↢ߓߡ߽㧘ߔߊߥߊߣ߽⍴ਛᦼ⊛ߦߪ㧘․ᱶේଔ⺞ᩏߢᷣ߹ߖ㧘ᾘ㔀ߥේଔ⸘▚೙ᐲߩ⾰ะ਄߹ߢߪขࠅ
⚵߹ߥ޿น⢻ᕈ߽޽ࠆ㧔⨹੗, 2006b,c㧕‫ޕ‬ታ㓙㧘ᣣᧄߢߪ 90 ᐕઍએ㒠㧘⚻༡▤ℂ⋡⊛߆ࠄߩේଔ⸘▚ߩ࠾࡯࠭ߪ㜞߹ߞߡ߈ߚ߇㧘ᒰೋߪ․ᱶේ
ଔ⺞ᩏߣߒߡߩේଔ⸘▚ߩታᣉ߇߶ߣࠎߤߢ޽ߞߚ㧔Arai, 2005㧕‫ޕ‬2000 ᐕ 1 ᦬ߩࠕࡦࠤ࡯࠻⺞ᩏߢߪ 6ഀᒝ߇ㇱ㐷೎ේଔ⸘▚ࠍታᣉߒߡ޿ࠆߣߒߡ޿ߚ߇㧔⨹੗, 2001a,b㧕㧘หᤨᦼߦታᣉߒߚࠗࡦ࠲ࡆࡘ࡯⺞ᩏߣวࠊߖࠆߣ㧘ߘߩᄢㇱಽߪ․ᱶේଔ⺞ᩏߣߒߡ޿߹߹ߢߦᢙ࿁ታᣉߒߚߎߣ߇޽ࠆߣ޿߁⒟ᐲߩ߽ߩ
ߢ޽ࠆࠃ߁ߢ޽ߞߚ‫ߩߘޕ‬ᓟ 2002 ᐕߦᄢⷙᮨߢ⋧ኻ⊛ߦ⚻༡▤ℂߦ㑐ᔃߩ㜞޿∛㒮⟲㧔ක≮⚻ᷣ⎇ⓥᯏ
᭴ߩળຬ∛㒮㧕ߦኻߒߡታᣉߒߚ⺞ᩏߢ߽㧘ᧄ᧪㧘ේଔ⸘▚ߦኻߔࠆ㑐ᔃ߇㜞ߊⷙᮨߩᄢ߈ߐ߆ࠄ޿ߞߡ
߽ዉ౉ࡔ࡝࠶࠻߇ᄢ߈޿∛㒮⟲ߦ޽ߞߡ߽㧘4 ഀᒙߩ∛㒮ߩߺ߇⚻Ᏹ⊛ߥේଔ⸘▚ࠪࠬ࠹ࡓࠍ᭴▽ߒߡ޿ߚ㧔Arai, 2004㧕‫ޕ‬ฦ∛㒮ߩ⚻༡▤ℂ⋡⊛ࠍ⢛᥊ߣߒߚࠃࠅࠃ޿ේଔᖱႎ࠾࡯࠭ߩ㜞߹ࠅߪ㧘ߎߩࠃ߁ߦዋ
ߥߊߣ߽ߔߋߦߪේଔ⸘▚ࠪࠬ࠹ࡓߩ᭴▽࡮ᡷༀߣߪ⚿߮ߟ޿ߡ޿߆ߥ޿น⢻ᕈ߇㜞޿ߣᕁࠊࠇࠆ‫ޕ‬߹ߚ㧘ఘㆶ⋡⊛߿࿖ቯଔᩰ⸳ቯ⋡⊛ߩߚ߼ߩႎ๔ේଔ⸘▚ߣ޿߁ⷰὐ߆ࠄߪ㧘ේଔ⸘▚ߩ⾰ะ਄ߩࠗࡦ
࠮ࡦ࠹ࠖࡉߪᔅߕߒ߽௛߆ߕ㧘߻ߒࠈᵴേ㊂ࠍᄙߊႎ๔ߒ࿖ቯଔᩰࠃࠅ߽ૐ޿ේଔߩታ⃻ࠍ࿑ࠆߣ޿ߞߚ
10)ߚߛߒㅪ↥ຠߩේଔ⸘▚ߩ໧㗴ߩߚ߼ߦ㧘ߎߩࠕࡊࡠ࡯࠴ߢ߽㧘ᒝ࿕ߢ⸵ኈߢ߈ࠆ⚿ᨐ߇▚಴ߐࠇߥ޿߆߽ߒࠇߥ޿႐ว߽޽ࠆߣᵈᗧᦠ߈ߒߡ޿ࠆ㧔DH, 2003a㧕‫ޕ‬㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

Game Playing ߩน⢻ᕈࠍ㜞߼㧘ේଔ⸘▚ᖱႎࠍᱡ߼ࠆ߆߽ߒࠇߥ޿‫ࠅ߹ߟޕ‬ႎ๔ේଔ⸘▚ߣ޿߁஥㕙߇㊀ⷞߐࠇࠆ޽߹ࠅ㧘ේଔ⸘▚ߩ⾰ะ਄ࠃࠅ߽⥄∛㒮ߦߣߞߡ᦭೑ߦߥࠆࠃ߁ߥේଔ⸘▚ᣇᴺߩㆬᛯ࡮ᄌᦝ
ࠍ⹜ߺࠆ߆߽ߒࠇߥ޿‫ޕ‬ታ㓙㧘ߎ߁ߒߚఘㆶ㗵ᦨᄢൻߣ޿߁ⷰὐ߆ࠄߩේଔ⸘▚ߩ᭴▽ߪ㧘ౝㇱᏒ႐೙ᐲਅߩ NHS ේଔ⸘▚ߦ߅޿ߡᄙߊ⷗ࠄࠇߡ߈ߚ㧔Ellwood, 1996a,b㧕‫ޕ‬ߐࠄߦ㧘ฦ∛㒮ߪ㧘⚻༡▤ℂ⋡⊛߆ࠄේଔ⸘▚ߩ⾰ࠍะ਄ߐߖߡ߽㧘ႎ๔ේଔ਄ߪᓥ᧪ߩ߹߹ߩ◲ᤃߥ
ᣇᴺߦၮߠ޿ߡ▚಴ߔࠆ߆߽ߒࠇߕ㧘ේଔ⸘▚ߩ⾰ߩะ਄߇ႎ๔ේଔߦ෻ᤋߐࠇߥ޿น⢻ᕈ߽޽ࠆ㧔⨹੗,
2006b㧕
‫ޕ‬ડᬺળ⸘ߦᄖㇱႎ๔ળ⸘ߣ⚻༡▤ℂߩߚ߼ߩ▤ℂળ⸘߇޽ࠆࠃ߁ߦ㧘∛㒮ේଔ⸘▚߇ႎ๔ේଔ⸘
▚ߣ⚻༡▤ℂේଔ⸘▚ߩੑᧄ┙ߡߢ⊒㆐ߒߡ޿ߊน⢻ᕈ߇޽ࠆ‫⊒ߚߒ߁ߎޕ‬ዷߪ㧘ߘ߽ߘ߽ႎ๔೙ᐲߢⷐ
᳞ߐࠇࠆේଔᖱႎߣ⚻༡▤ℂߢⷐ᳞ߐࠇࠆේଔᖱႎ߇⇣ߥࠆ㧔Ellwood, 1996a, pp.45-46㧕ߎߣ߇ᄢ߈ߊ
ᓇ㗀ߒߡ޿ࠆ‫ޕ‬ታ㓙㧘ႎ๔ේଔ⸘▚ࠍਥ⌒ߣߒߚේଔ⸘▚ࡑ࠾ࡘࠕ࡞ߦ߅޿ߡᚻᴺߩ⛔৻ൻ߇චಽߥߐࠇ
ߥ޿ℂ↱ߩ৻ߟߪ㧘୘‫∛ߩޘ‬㒮ߩ⚻༡▤ℂ࠾࡯࠭ߦ޽ߞߚේଔ⸘▚ᣇᴺߪᄙ᭽ߢ޽ࠅ㧘଻ஜ⋭ߣߒߡߪฦ
∛㒮ߩදജࠍᓧࠆߚ߼ߦ㧘ߎ߁ߒߚฦ∛㒮ߩ࠾࡯࠭ߦ৻ቯߩ㈩ᘦࠍߖߑࠆࠍᓧߥ޿߆ࠄߢ޽ࠆ㧔⨹੗,
2006a㧕
‫ޕ‬߽ߞߣ߽଻ஜ⋭ߩෳᾖේଔᜂᒰቭߪ㧘዁᧪⊛ߥಽൻߩน⢻ᕈࠍቢోߦߪุቯߢ߈ߥ޿ߣߒߟߟ߽㧘ႎ๔ේଔ⸘▚ߣ⚻༡▤ℂේଔ⸘▚ߩಽൻߪᒰ㕙ߪ⿠ߎࠄߥ޿ߩߢߪߥ޿߆ߣߒߡ޿ߚ‫ ߛ߹ޕ‬NHS ߩᖱႎࠪࠬ
࠹ࡓߩᢛ஻ᐲߪૐߊ㧘ಽൻߐߖࠆߛߌߩᖱႎ෼㓸߇ߢ߈ߥ޿ߒ૛⵨߽ߥ޿ߛࠈ߁ߣ޿߁‫⋙ߚ߹ޕ‬ᩏࠍ੹ᓟߒߞ߆ࠅߒߡ޿ߌ߫໧㗴ߪߥ޿ߣ߽ㅀߴߡ޿ߚ‫∛ߒ߆ߒޕ‬㒮߳ߩࠗࡦ࠲ࡆࡘ࡯⺞ᩏߦၮߠߌ߫㧘⚻༡▤ℂ
ߦⓍᭂ⊛ߦේଔ⸘▚ࠍᵴ↪ߒߡ޿ࠆ޽ࠆ∛㒮ߢߪႎ๔ේଔ⸘▚ߣ⚻༡▤ℂේଔ⸘▚ߩಽ㔌ߩళ୥߇⷗ࠄࠇ
㧔⨹੗, 2006b㧕㧘଻ஜ⋭ߩ⹺⼂ߣ⃻႐∛㒮ߩ⃻ታߣߩਵ㔌߇⷗ࠄࠇࠆ‫ޕ‬ߎ߁ߒߚߎߣ߆ࠄ㧘PbR ߦߣߞߡਇนᰳߥᱜ⏕ߥႎ๔ේଔ⸘▚೙ᐲߣ޿߁ⷰὐ߆ࠄߔࠆߣ㧘PbR ߩዉ౉ߦࠃࠅේଔ⸘▚ߩ⾰߇഍⊛ߦᡷༀߔࠆߛࠈ߁ߣ޿߁⹺⼂ߪ㧘଻ஜ⋭஥ߩᏗᦸ⊛᷹ⷰߦߔ߉ߥ޿ߣ޿߃ࠆ‫ޕ‬ߚߛෳᾖේଔ⸘▚ᜂᒰቭߦࠃࠇ߫㧘଻ஜ⋭߽ේଔ⸘▚ߩ⾰ะ਄ࠍߚߛᦼᓙߒߡ޿ࠆߛߌߢߪߥߊ㧘࿖ኅේଔ⸘▚ᚢ⇛ࠣ࡞࡯ࡊࠍౣ⚿ᚑߒ㧘⃻࿷㧘ේଔ⸘▚ࡊࡠ࠮ࠬߦ߅ߌࠆ࠺࡯࠲ߩᬌᩏ࡮⋙ᩏ߿ࠃࠅߒߞ߆ࠅߣ
ߒߚᣇᴺߩ⸥ㅀߥߤࠍ฽߻ේଔ⸘▚ᡷༀߩឭ᩺ࠍᬌ⸛ߒߡ޿ࠆ‫ࠅࠃߦࠇߎޕ‬ේଔ⸘▚ᚻᴺߩ∛㒮㑆ߢߩ৻⽾ᕈߩߥ޿߿ࠅᣇߦ㑐ߔࠆ ᔨߦኻᔕߒ㧘ේଔߩ⻉ⷐ⚛ߩࠃࠅᗧ๧ߩ޽ࠆᲧセࠍน⢻ߦߔࠆߣߒߡ޿ࠆ‫ޕ‬
3.2. Audit Commission ߦࠃࠆ NHS ේଔ⸘▚⺞ᩏߣ PbR ᤨઍ߳ะߌߚᡷༀᗧ⷗
Audit Commission ߪ㧘଻ஜ⋭ߣㅪ៤ߒߡ 2003 ᐕᐲߦߔߴߡߩ NHS ᯏ㑐ߦ߅޿ߡෳᾖේଔߩᱜ⏕ᕈߦߟ޿ߡߩᄖㇱ⋙ᩏࠍታᣉߒ㧘2008 ᐕᐲ߆ࠄᧄᩰㆇ↪ߔࠆ PbR ೙ᐲߩ࡝ࠬࠢߥߤࠍᜰ៰ߒߡ޿ࠆ‫ߩߘޕ‬ਛߢ㧘⃻ⴕߩෳᾖේଔ⸘▚ߩ໧㗴ὐࠍᜰ៰ߒ㧘PbR ᤨઍߦኻᔕߒߚේଔ⸘▚ߩᡷༀߩᔅⷐᕈࠍႎ๔ߒߡ޿ࠆ‫ޕ‬
PbR ೙ᐲਅߢߪ㧘᡽ᐭߩଔᩰ⸳ቯ㧘∛㒮෸߮৻ᰴ⸻≮ᯏ㑐㧔ឭଏ⠪㧕ߩ▵⚂࡮ᛩ⾗ᗧᕁ᳿ቯ㧘৻ᰴ⸻≮ᯏ㑐㧔ᆔ⸤⠪㧕ߩᡰᛄ޿ߩߚ߼ߦ㧘ේଔ෸߮ᵴേ㊂ߦߟ޿ߡߩ⾰ߩ㜞޿࠺࡯࠲߇ਇนᰳߢ޽ࠆ߇㧘ߎߎߦᄢ߈ߥ࡝ࠬࠢ߇޽ࠆߣߒߡ޿ࠆ‫ోߕ߹ޕ‬૕ߣߒߡ㧘ㆊඨߩක≮ᯏ㑐ߦ߅޿ߡෳᾖේଔߩᱜ⏕ᕈߦ 5㧑એ਄ߩਇ৻⥌߇޽ࠆߎߣ߇್᣿ߒߚ(AC, 2004, p. 20)‫৻ޕ‬ᰴ⸻≮ᯏ㑐ߢߪ 8 ഀ㧘♖␹∛㒮ߢߪ 7 ഀߩᯏ㑐ߦ߅ߌࠆෳᾖේଔ߇ 5㧑એ਄ߩਇᱜ⏕ᕈࠍ᦭ߒߡ߅ࠅ㧘⋧ኻ⊛ߦ⦟޿ᕆᕈᦼ∛㒮ߢ߽ 5 ഀࠍ⿥߃ࠆᯏ㑐ߢ 5㧑એ਄ߩਇᱜ⏕ᕈࠍᛴ߃ߡ޿ࠆ(p. 21)‫ޕ‬ਇᱜ⏕ߐߩ࡟ࡌ࡞ߪ৻ᰴ⸻≮ᯏ㑐߿♖␹∛㒮ߩᣇ߇ᕆᕈᦼ∛㒮ࠃࠅ߽ᄢ߈޿߇㧘ߎࠇࠄߩᯏ㑐ߪ 2008 ᐕ߹ߢߪ PbR ߩㆡ↪߇߶ߣࠎߤߥߐࠇߥ޿ߚ߼߹ߛᤨ㑆߇޽ࠆ৻ᣇ㧘ᕆᕈᦼ෸߮ኾ㐷∛㒮ߢߪ PbR ߩㆡ↪߇߽߁ᆎ߹ߞߡ޿ࠆߩߢ߽ߞߣᷓೞߢ޽ࠆߣߒߡ޿ࠆ㧔p. 20㧕‫ޕ‬ᰴߦ㧘ฦක≮ᯏ㑐ࠍ⺞ᩏߒߚᄖㇱ⋙ᩏੱ߇ෳᾖේଔ࠺࡯࠲ߩᱜ⏕ᕈߦ໧㗴ࠍᒁ߈⿠ߎߒߡ޿ࠆߣ⠨߃ࠆ㧙㧙

ࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿ਥⷐ㗔ၞ㧔ේଔ࠺࡯࠲㧘ᵴേ࠺࡯࠲㧘㈩⾮ᣇᴺ㧘ࠦ࡯࠼ൻ㧘කᏧ㑐ਈ㧘ߘߩઁ㧕ࠍ඙ಽߒ㧘㗔ၞ೎ߦ⺞ᩏߒߡ޿ࠆ‫ޕ‬ᕆᕈᦼ∛㒮ߢߪ㧘ᵴേ࠺࡯࠲ߩᱜ⏕ᕈߦ⚂ 3 ಽߩ 1 ߩ∛㒮߇໧㗴ࠍᛴ߃ߡ޿ࠆઁ㧘ේଔ࠺࡯࠲㧘
㈩⾮ᣇᴺ㧘
ࠦ࡯࠼ൻ㧘
කᏧ㑐ਈߩฦ㗔ၞߢ߽ߘࠇߙࠇ 15㧑೨ᓟߩ∛㒮߇໧㗴ࠍᛴ߃ߡ޿ࠆ(AC, 2004, p. 21)‫ޕ‬৻ᰴ⸻≮ᯏ㑐ߢ߽ห᭽ߦᵴേ࠺࡯࠲ߩ໧㗴ࠍ⚂ 3 ಽߩ 1 ߇ᜬߞߡ޿ࠆ߇㧘ᕆᕈᦼ∛㒮ߣᲧߴߡ㧘ේଔ࠺࡯
࠲෸߮㈩⾮ᣇᴺߦࠃࠅᄙߊߩᯏ㑐߇໧㗴ࠍᛴ߃ߡ޿ࠆ৻ᣇߢࠦ࡯࠼ൻߩ໧㗴ߪዋߥ޿‫ޕ‬ߥ߅ᢇᕆ∛㒮ߢߪ㧘ઁߩᯏ㑐ߣᲧセߒߡ㧘ේଔ㈩⾮ᣇᴺߣේଔ࠺࡯࠲ߦ⓭಴ߒߡᄢ߈ߥ໧㗴ࠍᛴ߃ߡ߅ࠅ㧘㈩⾮ᣇᴺߦ 6 ഀᒙ㧘ේଔ࠺࡯࠲ߦ 4 ഀᒝߩᱜ⏕ᕈ਄ߩ໧㗴ࠍᛴ߃ߡ޿ࠆ‫ޕ‬ේଔ࠺࡯࠲㗔ၞߩᱜ⏕ᕈߦߟ޿ߡߪ㧘߹ߕෳᾖේଔ⸘▚਄ߩේଔ࠺࡯࠲߇⽷ോળ⸘਄ߩൊቯ࠺࡯࠲߿ᄖ
ㇱ⽷ോႎ๔ᦠ࠺࡯࠲ߣ⺞๺࡮৻⥌ߔࠆ߆ߤ߁߆㧔ᢛวᕈ㧕ࠍ⺞ᩏߒ㧘ోක≮ᯏ㑐ߩ 3 ಽߩ 1 એ਄ߦ߅޿ߡ
⺞๺ߒߥ޿ߎߣ߇್᣿ߒߚ㧔AC, 2004, p. 22㧕‫ޕ‬ᕆᕈᦼ∛㒮ߢߪ 3 ഀએ਄㧘৻ᰴ⸻≮ᯏ㑐ߢߪ 4 ഀએ਄ߢේଔ࠺࡯࠲ߦ໧㗴ࠍᛴ߃ߡ޿ࠆ‫ޕ‬ේଔ⸘▚ࡑ࠾ࡘࠕ࡞ߢߪߎߩᢛวᕈࠍ㊀ⷞߒߡ޿ࠆ߇㧘ታ㓙ߦߪᄙߊߩ
ᯏ㑐ߢᢛวᕈߪ⏕଻ߐࠇߡ޿ߥ޿‫ߩߡߴߔߚ߹ޕ‬฽߼ࠆߴ߈㑐ㅪේଔ߇ෳᾖේଔߦ฽߹ࠇߡ޿ࠆ߆ߣ޿߁
ὐ߽⺞ᩏߒ㧘ᕆᕈᦼ∛㒮ߢߪ 2 ഀએ਄㧘৻ᰴ⸻≮ᯏ㑐߿♖␹∛㒮ߢߪ 3 ഀએ਄ߩᯏ㑐ߢ㑐ㅪේଔ߇฽߼ࠄ
ࠇߡ޿ߥ޿ߎߣ߇᣿ࠄ߆ߦߥߞߚ㧔p. 23㧕
‫⋥ߦࠄߐޕ‬ធ⾌࡮㑆ធ⾌࡮▤ℂ⾌ߩಽᨆࠍේଔ⸘▚ࡑ࠾ࡘࠕ࡞
ߦᓥߞߡታᣉߒߚ߆ߣ޿߁ⷰὐ߆ࠄ߽㧘ේଔ࠺࡯࠲ߩᱜ⏕ᕈࠍ⺞ᩏߒߡ߅ࠅ㧘ᕆᕈᦼ∛㒮෸߮♖␹∛㒮ߢ
ߪ 3 ಽߩ 1 એ਄㧘৻ᰴ⸻≮ᯏ㑐ߢߪ 5 ഀㄭߊߩᯏ㑐߇ࡑ࠾ࡘࠕ࡞ߦᓥߞߡ޿ߥ޿ߎߣ߇್᣿ߒߚ㧔p. 23㧕
‫ޕ‬ߎ߁ߒߚታᘒߪ㧘ᒰ⺞ᩏᓟ 2 ᐕߚߞߚ 2005 ᐕᐲߦ╩⠪߇ࠗࡦ࠲ࡆࡘ࡯ߒߚ޽ࠆᕆᕈᦼ∛㒮ߦ߅ߌࠆෳᾖ
ේଔ⸘▚ታോߣ߽৻⥌ߒߡ߅ࠅ㧔⨹੗㧘2006c㧕
㧘ߘߩᓟ߽޽߹ࠅᄌൻߒߡ޿ߥ޿ࠃ߁ߢ޽ࠆ‫ޕ‬ߎ߁ߒߚේଔ࠺࡯࠲ߩਇᱜ⏕ᕈߪ㧘200 એ਄ߩᯏ㑐߆ࠄߩෳᾖේଔߩว⸘ࠍ૶߁ߚ߼ߦ㧘࿖ቯଔᩰߩ⸳
ቯߦ߅޿ߡߪᄢ߈ߥ໧㗴ߣߪߥࠄߥ޿߆߽ߒࠇߥ޿߇㧘PbR ೙ᐲਅߢ↢߈ᱷࠆߚ߼ߦฦක≮ᯏ㑐߇ࠨ࡯ࡆࠬߩᄌᦝ߿▵⚂㗔ၞߩ᣿⏕ൻ߿ㅊട⾗Ḯߩ㈩ಽߥߤߩᗧᕁ᳿ቯࠍߔࠆ㓙ߦߪ㧘ฦක≮ᯏ㑐ߦߣߞߡ㕖Ᏹߦ໧㗴ߣߥࠆ߆߽ߒࠇߥ޿㧔AC, 2004, p. 24㧕
‫ޕ‬ฦᯏ㑐ߩ HRG ෳᾖේଔߩ㆑޿ߪ㧘ല₸ᕈࠍ⌀ߦ෻ᤋߒߡ޿
ࠆߚ߼ࠃࠅ߽㧘ਇᱜ⏕ߥේଔ⸘▚ߩߚ߼ߢ޽ࠆ߆߽ߒࠇߥ޿ߣߒߡ޿ࠆ‫ޕ‬ᰴߦᵴേ࠺࡯࠲ߩᱜ⏕ᕈߦߟ޿ߡ㧘ෳᾖේଔ೙ᐲ਄ߩᵴേ࠺࡯࠲߇ઁߩᵴേ࠺࡯࠲ႎ๔ᦠߣ⺞๺࡮৻⥌ߔࠆ߆㧘߹ߚᵴേႎ๔߇ߒ߫ߒ߫ଐ᜚ߔࠆᖚ⠪ฃ౉ࠪࠬ࠹ࡓߩ⃻⁁㧘ࠦ࡯࠼ൻߐࠇߥ޿ᵴേ㊂ߩ࡟ࡌ࡞㧘ࠍ⺞ᩏߒߡ޿ࠆ‫ޕ‬ෳᾖේଔ਄ߩᵴേ㊂ߪߒ߫ߒ߫ߘߩઁߩႎ๔ᵴേ࠺࡯࠲ߣ৻⥌ߖߕ㧘ฦක≮ᯏ㑐ߪߘߩᏅ⇣ߩℂ↱ࠍ⺑᣿ߢ߈ߥ޿ߎߣ߇್᣿ߒߚ㧔AC, 2004, p. 24㧕
‫ ߦ․ޕ‬17㧑ߩᯏ㑐ߩᵴേ࠺࡯࠲ߪ߆ߥࠅਇ
ᱜ⏕ߢ޽ࠆߣ್᣿ߒߚ‫ߚ߹ޕ‬ᕆᕈᦼ࡮ኾ㐷∛㒮ࠃࠅ߽৻ᰴ⸻≮ᯏ㑐࡮♖␹∛㒮ߩᣇ߇ᵴേ࠺࡯࠲ߦᄙߊߩ
໧㗴ࠍᛴ߃ߡ޿ࠆ‫ޕ‬ᖚ⠪ฃ౉ࠪࠬ࠹ࡓߪ PbR ߩዉ౉ߦࠃࠅ㊀ⷐᕈ߇㜞߹ࠅ㧘ᦨ߽ၮ␆⊛ߥᖱႎ࡮⽷ോ㧔੐ታ਄ߩ⺧᳞㧕ࠪࠬ࠹ࡓߣߥࠅߟߟ޽ࠆ߇㧘ᰴߩࠃ߁ߥ໧㗴ὐ߇್᣿ߒߚ㧔AC, 2004, p. 25㧕
‫ޕ‬Ԙ ߒ߫ߒ߫ 10 ᐕએ਄૶ࠊࠇߡ޿ࠆฎ޿ࠪࠬ࠹ࡓߢ㧘⃻࿷ᔅⷐߥ࠺࡯࠲▸࿐ࠍߔߴߡಣℂߢ߈ࠆࠃ߁ߦߪ⸳⸘ߐࠇߡ޿ߥ޿ԙ ߘߩࠪࠬ࠹ࡓ߆ࠄਥⷐߥᬺ❣࠺࡯࠲ࠍ᛽಴ߔࠆߎߣߦฦᯏ㑐ߪ࿎㔍ࠍᗵߓߡ޿ࠆԚ ᖱႎᛛⴚ਄ߩ໧㗴ߪႎ๔਄ߩ⺋ࠅߩẜ࿷⊛ߥⷐ࿃ߣߥߞߡ޿ࠆ
ࠦ࡯࠼ൻߐࠇߥ޿ᵴേ㊂࡟ࡌ࡞ߦߟ޿ߡߪ㧘14㧑ߩක≮ᯏ㑐߇ 3㧑એ਄ߩᵴേࠍಽ㘃ߒߡ޿ߥ޿ߎߣ߇
್᣿ߒߚ㧔AC, 2004, p. 26㧕
‫࠼࡯ࠦߒߛߚޕ‬ൻߐࠇߥ޿ᵴേߦኻߒߡߪᡰᛄ޿ࠍߒߥ޿ߎߣࠍ଻ஜ⋭߇᣿⏕ߦߒߡ޿ࠆߚ߼㧘Ⓧᭂ⊛ߥࠦ࡯࠼ൻߩᒝ޿േᯏ߇੹ᓟ௛ߊߚ߼㧘ߎࠇߪᄢ߈ߥ໧㗴ߢߪߥߊߥࠅ㧘߻ߒࠈਇᱜ⏕ߥࠦ࡯࠼ൻ㧔႐วߦࠃߞߡߪᖡᗧߦࠃࠆ㧕߇੹ᓟ໧㗴ߦߥࠆߣߒߡ޿ࠆ‫ޕ‬ᱜ⏕ߥࠦ࡯࠼ൻߦߪකᏧ
㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕ߩ㑐ਈ㧔ࠦ࡯࠼ൻᜂᒰ⠪ߣߩදജ㧕߇㊀ⷐߛ߇㧘ߚߞߚߩ 8㧑ߩක≮ࠬ࠲࠶ࡈߩߺ߇ࠦ࡯࠼ൻߦ㑐ਈߒߡ޿ࠆ⃻⁁ߢ޽ࠆ㧔p. 27㧕
‫ޕ‬Northcott ࠄߩ⺞ᩏߢ߽㧘ળ⸘ᜂᒰ⠪߇ HRG ේଔࠍ⸘▚ߔࠆߚ߼ߦߪ⸻≮ታോߦኒធߦ㑐ଥߒߡ޿ࠆකᏧ߆ࠄߩᵴേ㑐ㅪᖱႎ߇㊀ⷐߢ޽ࠆ߇㧘ෳᾖේଔߦ߶ߣࠎߤ㑐ᔃࠍᜬߞߡ޿ߥ޿
කᏧ߆ࠄᖱႎࠍᓧࠆߎߣߦ࿎㔍ߒߡ޿ࠆ⁁ᴫ߇᣿ࠄ߆ߦߐࠇߡ޿ࠆ㧔Northcott and Llewellyn, 2002a,p.41㧕
‫ޕ‬කᏧߦࠃߞߡߪෳᾖේଔᵴേߢⷐ᳞ߐࠇߡ޿ࠆᖱႎ෼㓸߳ߩෳടࠍᜎุߐ߃ߒ㧘ળ⸘ᜂᒰ⠪ࠄߣߩ✕ᒛߒߚ㑐ଥࠍ↢ࠎߢ߈ߚߣ޿߁㧔p.41㧕
‫ޕ‬ߐࠄߦේଔ㈩⾮ߩᱜ⏕ᕈߦߟ޿ߡߪ㧘߹ߕ⸻≮⑼╬߳ߩ⋥ធ⾌ߩㆡಾߥ⋥⺖ߦ㑐ߒߡߪ㧘ߤߩ⒳㘃ߩක≮ᯏ㑐ߦ߅޿ߡ߽ 9 ഀએ਄ߦ߅޿ߡታ⃻ߒߡ޿ࠆߎߣ߇್᣿ߒߚ㧔AC, 2004, p. 28㧕
‫ߚ߹ޕ‬㑆ធ⾌෸߮▤ℂ⾌ߩ㈩⾮߇ේଔ⸘▚ࡑ࠾ࡘࠕ࡞ߦᓥߞߡߥߐࠇߡ޿ࠆ߆ߣ޿߁ⷰὐ߆ࠄߩ㈩⾮ߩᱜ⏕ᕈߦߟ޿ߡߪ㧘ࡑ࠾ࡘࠕ࡞ߦᓥߞߡ޿ߥ޿ᯏ㑐ߪ㧘ᕆᕈᦼ∛㒮ߢߪ 1 ഀએਅߢ޽ࠆ߽ߩߩ㧘৻ᰴ⸻≮ᯏ㑐ߢߪ⚂ 3 ಽߩ 1㧘♖␹∛㒮ߢߪ⚂ 4 ಽߩ 1 ߦߩ߷ࠅ㧘ᡷༀߩ૛࿾߇ᄢ߈޿ߎߣ߇᣿ࠄ߆ߦߥߞߚ㧔p. 28㧕
‫ޕ‬߹ߚ㧘PbR ೙ᐲߦኻᔕߒߡࠨ࡯ࡆࠬᄌᦝࠍߔࠆ੍▚▤ℂᜂᒰ⠪߇㧘ේଔ⸘▚߇ᱜ⏕ߢ᦭ലߢ޽ࠆߣ⏕ታߦ⹺⼂ߔࠆߚ߼ߦߪ㧘ේଔ෸߮ᵴേ࠺࡯࠲ߦኻߔࠆකᏧߩᡰេࠍᓧࠆߎߣ߇㊀ⷐߢ޽ࠆ߇㧘ߎߎߦߪᄢ߈
ߥᡷༀߩ૛࿾߇޽ࠆ‫ޕ‬කᏧ߿▤ℂ⠪߇ේଔ⸘▚ࡊࡠ࠮ࠬߦ‫ߣࠅ߆ߞߒޟ‬㑐ਈߒߡ߈ߚ‫ࠆߔߣޠ‬ᯏ㑐ߪ㧘ᕆᕈᦼ∛㒮ߢߪ 3 ഀᧂḩ㧘৻ᰴ⸻≮ᯏ㑐࡮♖␹∛㒮ߢߪ 2 ഀ೨ᓟߢ޽ࠅ㧘৻ᰴ⸻≮ᯏ㑐࡮♖␹∛㒮ߢߪ‫ోޟ‬ߊ㑐ਈߒߡ޿ߥ޿‫ޠ‬ᯏ㑐߽ᄙ޿㧔AC, 2004, p. 29㧕‫ޕ‬ട߃ߡ㧘∛㒮ో૕ߣߒߡߩෳᾖේଔ਄ߩઁ∛㒮ߣᲧセߒߚ૏⟎ߦ㑐ߒߡߪ㧘ᄙዋߩ ᔨ߇޽ࠆ߽ߩߩ߅
߅߻ߨ‫౏ޟ‬ᱜ‫߇޿ߥࠇߒ߽߆ࠆ޽ߢޠ‬㧘ฦ⸻≮⑼╬࡟ࡌ࡞ߩᬺ❣ࠍ␜ߔ߽ߩߣߒߡߪ㧘ෳᾖේଔߪା㗬ᕈ߇ૐ޿ߣ⠨߃ࠆߴ߈ߢ޽ࠆߣߒߡ޿ࠆ㧔AC, 2004, p. 29㧕
‫∛ޕ‬㒮㑆ߩห৻ HRG ߩේଔߩ㆑޿ࠃࠅ߽㧘㒮ౝฦ⸻≮⑼╬ߩᬺ❣ࠍ␜ໂߔࠆ㑐ㅪ HRG ේଔߩో࿖ᐔဋ୯߆ࠄߩਵ㔌ᐲߩห৻∛㒮ౝฦ⸻≮⑼╬㑆ߩ㆑޿ߩᣇ߇ᄢ߈ߊ㧘޽ࠆౖဳ⊛ߥ∛㒮ߢߪ㧘ฦ⸻≮⑼╬ࠍઍ⴫ߔࠆਥⷐ HRG ේଔߩో࿖ᐔဋ߆ࠄߩਵ㔌ᐲ߇⸻≮⑼╬㑆ߢ 6 ୚߽⇣ߥߞߡ޿ࠆߣ޿߁㧔pp. 29-30㧕
‫ࠅ߹ߟޕ‬ᣢሽߩෳᾖේଔ࠺࡯࠲ߦࠃࠇ߫㧘ෳᾖේଔ߇ല₸ᕈߩ㆑޿ࠍ෻ᤋߒߡ޿ࠆߣߔࠆߥࠄ߫㧘∛㒮㑆ߩല₸ᕈߩ㆑޿ࠃࠅ߽㧘ห৻∛㒮ౝߩ⸻≮⑼╬㑆ߩല₸ᕈߩ㆑޿ߩᣇ߇ᄢ߈޿ߎߣߦߥࠆ‫⁁ߚߒ߁ߘޕ‬ᴫߪਇ⥄ὼߢ޽ࠆߚ߼ 11)㧘ෳᾖේଔߪ㧘∛㒮ౝߦല₸ᕈߩ㊀ⷐᕈߦ㑐ߔࠆ⹺⼂ࠍਈ߃ࠆ߇㧘⚻༡ᗧᕁ᳿ቯߩၮ␆ࠍᒻᚑߔࠆߦචಽߥ߶ߤ߹ߛା㗬ߢ߈ࠆ߽ߩߢ
ߪߥ޿ߣ⼊๔ߐࠇߡ޿ࠆ㧔p. 29㧕12)‫ޕ‬
Audit Commission ߪෳᾖේଔ⸘▚ߦ㑐ߔࠆߎ߁ߒߚో∛㒮⺞ᩏ⚿ᨐࠍၮߦ㧘ᕆᕈᦼ∛㒮ߩේଔᖱႎߪ
࿖ቯଔᩰ⸳ቯߩߚ߼ߦߪචಽᱜ⏕ߢ޽ࠆ߆߽ߒࠇߥ޿߇㧘ฦ∛㒮࡟ࡌ࡞㧘․ߦฦ⸻≮⑼╬࡟ࡌ࡞ߢߪ㧘ᬺ❣㧔ේଔ㧕ߩ㆑޿ߪല₸ᕈߩ㆑޿ߢߪߥߊේଔߩᛠី෸߮㈩⾮ᣇᴺߩ㆑޿ߦࠃࠅ⺑᣿ߐࠇࠆ߆߽ߒࠇߕ㧘⋧ኻ⊛ߦା㗬ᕈ߇ૐ޿㧔p. 31㧕㧘ߣ⚿⺰ߠߌߡ޿ࠆ‫⁁ߩߎߡߒߘޕ‬ᴫࠍ⸃᳿ߔࠆߚ߼ߦ㧘ᰴߩࠃ߁ߥផᅑ
ࠍߒߡ޿ࠆ㧔AC, 2004, pp. 31-32㧕‫ޕ‬Ԙ ฦ∛㒮ߪᖚ⠪ᵴേࠍᱜ⏕ߦ⸥㍳ߒࠦ࡯࠼ൻߔࠆ⢻ജߦ⋥ߜߦᛩ⾗ߒ㜞߼ࠆߴ߈ԙ ฦ∛㒮ߩᵴേ෸߮ෳᾖේଔ࠺࡯࠲ߪ⁛┙ᯏ㑐ߦࠃࠆቯᦼ⊛ߥᬌᩏߦߐࠄߐࠇࠆߴ߈Ԛ ∛㒮ߪේଔ⸘▚෸߮ࠦ࡯࠼ൻ߳ߩකᏧߩ㑐ਈࠍ⏕ታߦ㜞߼ࠆߴ߈ԛ ∛㒮ߪේଔ▵⚂ᗧᕁ᳿ቯ߿ᛩ⾗ᗧᕁ᳿ቯߩၮ␆ߣߒߡฦ⸻≮⑼╬࡟ࡌ࡞ߩෳᾖේଔࠍ೑↪ߔࠆߎߣߦᵈᗧߔߴ߈
11) ∛㒮ో૕ߣߒߡઁ∛㒮ࠃࠅ߽ല₸ᕈߩࠃ޿∛㒮ߢߪ㧘ၮᧄ⊛ߦߤߩࠃ߁ߥਥⷐ HRG㧔㑐ㅪ⸻≮⑼╬㧕ߦ㑐ߒߡ߽⋧ኻ⊛ߥല₸ᕈ߇ࠃ޿ߪ
ߕߢ޽ࠆߣ޿߁⠨߃ᣇ߇ߎߩਥᒛߩ೨ឭߣߥߞߡ޿ࠆ‫ߚߒ߁ߎޕ‬೨ឭߦ┙ߚߥߌࠇ߫㧘ో࿖ᐔဋ୯߆ࠄߩਵ㔌ᐲ߇ਥⷐ HRG 㑆ߢᄢ߈ߊ⇣ߥߞߡ޿ߚߣߒߡ߽㧘ߘࠇߪᔅߕߒ߽ේଔ㈩⾮਄ߩ໧㗴ߣߪ޿߃ߕ㧘ෳᾖේଔ߇㑐ㅪ⸻≮⑼╬ߩᬺ❣(ല₸ᕈ)ࠍ␜ໂߒߡ޿ߥ޿ߣߪ⸒߃ߥ޿‫ޕ‬12) ߎߩઁߦ㧘⃻႐ߢߩᗧᕁ᳿ቯߩᔅⷐ߇޽ࠆකᏧ߿▤ℂ⠪ߪ㧘ᔅߕߒ߽ෳᾖේଔᵴേߦ㑐ਈߒߡ޿ߥ޿ߣ޿߁໧㗴߽ᜰ៰ߐࠇߡ޿ࠆ‫ޕ‬㧙㧙

ࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿Ԝ ৻ᰴ⸻≮ᯏ㑐㧔ᆔ⸤⠪㧕ߪ∛㒮ߩᵴേᖱႎࠍⓍᭂ⊛ߦ⋙ⷞߔߴ߈ԝ ৻ᰴ⸻≮ᯏ㑐㧔ឭଏ⠪㧕෸߮♖␹∛㒮ߪ㧘ේଔ⸘▚෸߮ᵴേᖱႎࠍᡷༀߔࠆߚ߼ߩⴕേࡊࡠࠣ
࡜ࡓࠍ⋥ߜߦዉ౉ߔߴ߈Ԟ ଻ஜ⋭ߪ∛㒮࠺࡯࠲ߩ⋙ᩏ࡮♖ᩏߩߚ߼ߩ᦭ലߥࠪࠬ࠹ࡓࠍዉ౉ߔߴ߈ԟ ଻ஜ⋭ߪࠦ࡯࠼ൻࠟࠗ࠼࡜ࠗࡦࠍ PbR ะߌߦቢోߦୃᱜ࡮ᦝᣂߒ㧘ㆡಾߥ⎇ୃࠍឭଏߔߴ߈
ߎߩઁߦ߽ේଔ⸘▚㑐ㅪ੐㗄ߣߒߡ㧘NHS ේଔߩ߆ߥࠅߩㇱಽߪ⍴ᦼ⊛ߦߪ▤ℂਇ⢻ߥ࿕ቯ⾌ߢ޽ࠆߚ߼㧘ోㇱᐔဋේଔߦၮߠߊ⾗㊄ଏ⛎ߩ⒟ᐲࠍ๺ࠄߍߡ∛㒮ߩ⽷ോ࡝ࠬࠢࠍૐߊߔࠆߚ߼ߦ㧘ઁߩ࡛࡯ࡠ
࠶ࡄ⻉࿖ߩࠃ߁ߦ࿕ቯ⾌ߣᄌേ⾌ࠍ෻ᤋߒߚ⾗㊄ଏ⛎ࠍ⠨ᘦߔࠆᔅⷐ߇޽ࠅ㧘ߘߩߚ߼ߦߪ㕖Ᏹߦ᣿⏕ߥ࿕ቯ⾌ߣᄌേ⾌ߩ඙ಽቯ⟵ߣ㧘෩ኒߥේଔ⸘▚ࠟࠗ࠳ࡦࠬ෸߮⋙ⷞ߇ᔅⷐߦߥࠆߣਥᒛߒߡ޿ࠆ㧔AC,
2004, p. 35㧕
‫ߚ߹ޕ‬ක≮ᛛⴚߩㅴᱠߦวࠊߖߡ HRG ෸߮ߘߩේଔ⸘▚ࠍᦝᣂߒߡ޿߆ߥ޿ߣ㧘∛㒮ߦᛛⴚㅴᱠ߳ߩࡑࠗ࠽ࠬߩേᯏࠍਈ߃ࠆߎߣߦߥࠆߩߢᵈᗧߔߴ߈ߎߣ߽ᜰ៰ߐࠇߡ޿ࠆ㧔p. 38㧕‫ޕ‬

㧠㧚NHS ේଔ⸘▚ߩᣂዷ㐿
2008 ᐕᐲ߆ࠄߩ PbR ߩᧄᩰㆇ↪ߦะߌߡ㧘NHS ߩේଔ⸘▚ߪ⃻࿷ᣂߒ޿ዷ㐿ࠍᮨ⚝ਛߢ޽ࠆ‫ޕ‬PbR
ߦኻᔕߒߚේଔ⸘▚ኻ⽎ߩౣ⸳⸘߿㧘∛㒮㑆ߩ⛔৻ᕈࠍᒝൻߔࠆߚ߼ߩේଔ⸘▚ኻ⽎න૏ᢙ᷹ቯᴺߩᄌᦝ㧘ේଔ㈩⾮ᴺߩ⛔৻ᕈࠍᒝൻߔࠆߚ߼ߩᮡḰൻߐࠇߚ࿖ኅේଔ⸘▚࠰ࡈ࠻ߩน⢻ᕈߩᬌ⸛㧘ේଔ⸘▚⽶ᜂシᷫߩߚ߼ߩઍᦧ⊛ේଔ⸘▚೙ᐲߩᬌ⸛㧘⛔৻ᕈ࡮ା㗬ᕈ࡮⚊ᓧᕈ⏕଻ߩߚ߼ߩࡑ࠾ࡘࠕ࡞Ḱ᜚ᕈᒝൻ╷ߣߒߡߩේଔ⸘▚⋙ᩏߩᧄᩰൻ㧘ߥߤ߇⷗ࠄࠇࠆ‫ޕ‬
4.1. ේଔ⸘▚ኻ⽎ߣߒߡߩ⸻ᢿ⟲ಽ㘃ߩౣ⸳⸘90 ᐕઍࠃࠅේଔ⸘▚ኻ⽎ߣߥࠆ⸻ᢿ⟲ಽ㘃ߣߒߡ HRG ߇㐿⊒ߐࠇߡ߈ߚ߇㧘ห৻ HRG ౝߢߩ⾗Ḯᶖ⾌㗵ߩࡃ࡜࠷ࠠߩࠃࠅዋߥ޿ಽ㘃߳ߣᵞ✵ൻ߇⛮⛯⊛ߦㅴ߼ࠄࠇߡ߈ߚ‫ᦨޕ‬ㄭߢ߽㧘ᓥ᧪ߩ 3.0
ߡ㧘ዊߐߥୃᱜࠍߒߚ 3.5

ߦઍ߃߳ߣ HRG ߇ᵞ✵ൻߐࠇ㧘2005 ᐕᐲ߆ࠄߪ㧘ߎߩ ߇ේଔ⸘▚ኻ⽎ߣߒߡ↪

޿ࠄࠇߡ޿ࠆ‫ ߚ߹ޕ‬2008 ᐕᐲ߆ࠄߪ㧘PbR ೙ᐲߩᧄᩰㆇ↪ߦኻᔕߔࠆߚ߼ߦ㧘ᓥ᧪ߩ HRG ಽ㘃ࠍ⻉ⷐ⚛߳ಽ⸃ߒߚ 4.0

ߩ HRG ߇ේଔ⸘▚ኻ⽎ߣߥࠆ੍ቯߢ޽ࠅ㧘⃻࿷㐿⊒߇ᆎ߹ߞߡ޿ࠆ‫ޕ‬HRG4.0ߪ㧘Ԙ࿷㒮ᣣᢙߩࠃ߁ߥઍℂዤᐲߢߪߥߊోㇱ⾗Ḯේଔߦၮߠߊಽ㘃㧘ԙOPCS4 ߦઍ߃ߡᣂߒ޿ National
Intervention Classification ࠍ↪޿ߡ㐿⊒㧘Ԛᴦ≮႐ᚲߦ㑐ࠊࠄߥ޿ᖚ⠪ಽ㘃㧘ԛᄙ᭽ߥឭଏਥ૕ߦࠃࠅ
ឭଏߐࠇߡ޿ࠆ
㧔ߐࠇ߁ࠆ㧕
⻉ࠤࠕⷐ⚛߳ߩ৻ㅪ⸻≮ࠤࠕߩಽ⸃㧘ߣ޿߁ਥⷐߥ․ᓽࠍ᦭ߔࠆ
㧔DH, 2003b㧕‫ޕ‬Ԙߦߟ޿ߡߪ㧘HRG ߇ല₸ᕈࡌࡦ࠴ࡑ࡯ࠢ⋡⊛ਛᔃߩන૏߆ࠄᡰᛄ޿න૏ߣߥߞߚߚ߼ߦ㧘ല₸ᕈߩ
ઍℂᄌᢙߢ޽ࠆ࿷㒮ᣣᢙߢߩಽ㘃ߢߪਇචಽߢ㧘㊄㗵ࡌ࡯ࠬߢߩ㆑޿ࠍࠃࠅ⋥ធ߆ߟᱜ⏕ߦ෻ᤋߒߚಽ㘃ߦߔࠆᔅⷐ߇޽ࠆߚ߼ߩᄌᦝߢ޽ࠆߣ޿߃ࠆ‫ ߪߦ߼ߚߩߎޕ‬HRG ಽ㘃⸳ቯߩߚ߼ߩᧄᩰ⊛ߥ․ᱶේଔ⺞ᩏ߇ᔅⷐߣߥࠆߛࠈ߁‫ߚ߹ޕ‬ԛߦߟ޿ߡߪ㧘޿߹߹ߢߩ HRG ࠃࠅ߽⚦߆ߊಽ⸃ߐࠇߚන૏߇ේଔ⸘▚ኻ⽎ߣߥࠆߎߣࠍᗧ๧ߒߡ߅ࠅ㧘ߎߩߎߣߦࠃࠅ㧘ᄙ᭽ߥࠤࠕࡄࠬߩ✚ේଔߩ▚಴߿ࠤࠕࡄࠬߩ޿ࠈ޿ࠈߥ
Ბ㓏ߩ⚵ߺวࠊߖߩว⸘ේଔߩ▚಴߇น⢻ߣߥࠅ㧘ᖚ⠪ߩㆬᛯߦၮߠߊᄙ᭽ߥឭଏ⠪ߦࠃࠆᄙ᭽ߥක≮ឭ
ଏᣇᴺࠍᡰ߃ࠆ⾗㊄ଏ⛎ࠪࠬ࠹ࡓ߇น⢻ߣߥࠆ‫ޕ‬߹ߚ HRG4.0ߢߪ㧘ቯ⟵ߐࠇࠆࠨ࡯ࡆࠬߩᢙ߿▸࿐߇⪺ߒߊ᜛ᄢߒ㧘⃻࿷ࠦ࡯࠼ࠍ᦭ߒߡ޿ߥ޿⻉ࠨ࡯ࡆࠬߩࠣ࡞࡯ࡊൻ߽ߥߐࠇࠆߚ߼㧘ේଔ⸘▚෸߮ᵴേ࡮⚻༡ᖱႎࡊࡠ࠮ࠬߦ⪺ߒ޿ᓇ㗀ࠍᜬߜ߁ࠆ‫ߘޕ‬ߎߢ HRG ⷗⋥ߒߦࠃࠆẜ࿷⊛ߥᓇ㗀ࠍ੍᷹ߒ㧘ේଔ⸘▚෸߮ᵴേߩࡊࡠ࠮ࠬ෸߮ࠪࠬ࠹ࡓ߳ߩᓇ㗀ߦ㑐ߔࠆ⷗⸃ࠍ⹏ଔߔࠆߣߒߡ޿ࠆ㧔DH, 2003b㧕
‫ߪࠇߎޕ‬ේଔ⸘▚ኻ⽎ߣߒߡߩ HRG ߩᄌᦝ߇޿߆ߦේଔ⸘
㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

▚ߩࡊࡠ࠮ࠬ෸߮ࠪࠬ࠹ࡓߦᄢ߈ߥᓇ㗀ࠍ߽ߚࠄߔ߆ࠍ␜ߒߡ޿ࠆ‫ޕ‬ක≮⇇ߦ߅޿ߡߪ㧘⵾ㅧᬺ⇇ߣ⇣ߥࠅ㧘ේଔ⸘▚ኻ⽎ߣߔߴ߈ක≮ࠨ࡯ࡆࠬ㧔⵾ຠ㧕න૏ߩ⸳ቯ߇㕖Ᏹߦ࿎㔍ߢ޽ࠆߣ޿߁໧㗴߇޽ࠆ‫ࠅ޽߽ߣߎߩߘޕ‬㧘વ⛔⊛ߦක≮⇇ߦ߅޿ߡߪ㧘ㇱ㐷೎ේଔ⸘▚ߪߣ߽߆ߊߣߒߡ㧘ᖚ⠪߳ߩ൮᜝⊛ߥឭଏක≮ࠨ࡯ࡆࠬࠍኻ⽎ߣߒߚේଔ⸘▚ߪ⊒㆐ߒߡߎߥ߆ߞߚ‫ࡔࠕߒ߆ߒޕ‬࡝ࠞߦ߅ߌࠆ DRG ࠍೋ߼ߣߒߡ㧘⥃ᐥ⊛㘃ૃᕈߣ⾗Ḯᶖ⾌㘃ૃᕈߦࠃࠆ⸻ᢿ⟲㧔ᖚ⠪㧕ಽ㘃ᴺߩᕆㅦߥ⊒㆐ߦࠃࠅ㧘ࠕࡔ࡝ࠞߢߪ 80 ᐕઍએ㒠㧘ࠗࠡ࡝ࠬߢߪ 90 ᐕઍએ㒠㧘ᖚ⠪߳ߩ൮᜝⊛ߥឭଏක≮ࠨ࡯ࡆࠬࠍኻ⽎ߣߒߚේଔ⸘▚߇น⢻ߣߥߞߡ߈ߡ޿ࠆ‫ߛߚޕ‬ዋߥߊߣ߽ࠗࠡ࡝ࠬߢߪ㧘߹ߛ⾗Ḯᶖ⾌ߩࡃ࡜࠷ࠠ
߇ᄢ߈޿㗔ၞ߽޽ࠅ㧘HRG ߩᵞ✵ൻ߇ߥߐࠇߡ޿ࠆઁ㧘߹ߛ HRG ಽ㘃߇ߥߐࠇߡ޿ߥ޿ක≮ಽ㊁߽޽ࠆ‫ߢ▵ᧄߚ߹ޕ‬ㅀߴߚࠃ߁ߦ㧘ᣂߒ޿⾗㊄ଏ⛎೙ᐲߦኻᔕߒߚ HRG ಽ㘃ߩᄢ߈ߥᄌ㕟߽⺖㗴ߣߥߞߡ޿
ࠆ‫ޕ‬
4.2. ේଔ⸘▚ኻ⽎ߩන૏ᢙ᷹ቯᴺߩᄌᦝ
2005 ᐕᐲ߆ࠄ㧘ේଔ⸘▚ኻ⽎ߣߒߡߩ⸻ᢿ⟲ಽ㘃㧔HRG㧕ߩන૏ᢙ᷹ቯᴺ߇㧘ᓥ᧪ߩ FCE㧔Finished
Consultant Episode㧦৻ੱߩਥᴦකߦࠃࠆ⸻≮ߩቢੌ㧕ߦࠃࠆ᷹ቯ߆ࠄ㧘Spell㧔৻౉㒮ߩቢੌ㧕ߦࠃࠆ᷹ቯߦᄌᦝߐࠇߚ‫ޕ‬ฦ∛㒮ߦࠃߞߡ㧘౉㒮ฃ౉∛᫟ߩ⸳⟎ߩ᦭ή߿ᖚ⠪ߩਥᴦක㑆ߩ⒖ォ㗫ᐲ߇߆ߥࠅ⇣ߥࠆߚ߼㧘ห৻ߩක≮ౝኈߢ޽ߞߡ߽∛㒮ߦࠃߞߡ FCE ᢙ߇⇣ߥࠅ㧘߹ߚߎ߁ߒߚ㆑޿ߪߔߢߦฦ∛㒮ߦᩮઃ޿ߡ޿ࠆߚ߼ᄌᦝߪ࿎㔍ߢ޽ࠆ‫৻ߚ߹ޕ‬࿁ߩ Spell ߦ߅޿ߡⶄᢙߩ FCE ߇޽ࠅⶄᢙߩ FCE ߇ห৻ߩHRG ߦಽ㘃ߐࠇࠆ႐ว㧔ߎ߁޿߁ࠤ࡯ࠬ߇ㆊඨߢ޽ࠆ㧕㧘∛㒮ߦࠃߞߡฦ FCE ࠍ೎‫ߩޘ‬ᵴേߣߒߡᢙ߃
ࠆߣߎࠈߣ㧘߹ߣ߼ߡ৻࿁ߩᵴേߣߒߡᢙ߃ࠆߣߎࠈ߇޽ࠆ㧔DH, 2004㧕13)‫ ߡߞ߇ߚߒޕ‬FCE ߩ߹߹ߢߪ㧘ฦ∛㒮ߩฦ HRG ේଔ߇⛔৻ߩන૏ᢙ᷹ቯᴺߦࠃࠅ⸘▚ߐࠇߥ޿ߚ߼㧘HRG ೎ᐔဋේଔߪ࿖ቯଔᩰ
▚ቯߩၮ␆ߣߒߡ⪺ߒߊା㗬ᕈߦᰳߌࠆ߽ߩߣߥߞߡߒ߹߁‫ޕ‬ታ㓙㧘ห৻ Spell ౝߩᓟ⛮ FCE ߇೨ߩ FCE ߣห৻ߩ HRG ࠦ࡯࠼ߢ޽ࠆ FCE ࠍࠃࠅᄙߊ᦭ߔࠆ∛㒮ߪ㧘ઁ∛㒮ࠃࠅ߽ૐ޿ෳᾖේଔࠗࡦ࠺࠶ࠢࠬࠍ␜ߔ௑ะ߇޽ࠅ㧘․ቯߩ∛㒮߇ FCE ࠍಽߌߡ⸘᷹ߔࠆߎ
ߣߦࠃࠅ㧘ਇᒰߦଢ⋉ࠍᓧߡ޿ࠆน⢻ᕈ߇␜ໂߐࠇߡ޿ࠆ㧔DH, 2004㧕‫଻ߚߒ࡯ࡘࡆ࠲ࡦࠗߚ߹ޕ‬ஜ⋭ߩෳᾖේଔᜂᒰቭߪ㧘ᦨᄢߩ⺖㗴ߪ㧘ේଔ⸘▚ᚻᴺߘߩ߽ߩࠃࠅ߽㧘߻ߒࠈන૏ේଔࠍ▚ቯߔࠆߚ߼ߩන૏
ᢙߩ᷹ቯᴺߩ৻⽾ᕈ࡮Ყセน⢻ᕈߩ⏕଻ߢ޽ࠆߣߒߡ޿ߚ‫ߪࠬࡦ࠳ࠗࠟޕ‬ᄙ᭽ߦ⸃㉼ߐࠇ߁ࠆߒ㧘⃻႐ߢߩ㕖Ᏹߦᄙ᭽ߥࠨ࡯ࡆࠬឭଏᣇᴺ߇න૏ᢙ᷹ቯᴺߩᷙੂ߳ߣዉ߈߁ࠆߣㅀߴߡ޿ߚ‫ߢߎߘޕ‬න૏ᢙߩ᷹ቯ
ᣇᴺߦ∛㒮㑆ߩ㆑޿߇⷗ࠄࠇߥ޿ Spell ߦࠃࠆ᷹ቯߦᄌᦝߐࠇࠆߎߣߣߥߞߚ‫ޕ‬ߎ߁ߒߚන૏ᢙ᷹ቯᴺߩᄌᦝߪ㧘ᄖ᧪㗔ၞߢ߽⷗ࠄࠇࠆ‫ޕ‬ᓥ᧪ߪ Episode න૏ߢ޽ߞߚ߇㧘ኾ㐷ක≮∛㒮ߩࠃࠅⶄ㔀ߥࠤ࡯ࠬࠍㆡಾߦ෻ᤋߒߡ޿ߥ޿ߎߣ߿㧘৻ߟߩ Episode ࠍಽഀߒߡㆡಾߥㇱಽࠍㆡಾߥឭ
ଏਥ૕ߦછߖࠆߣ޿߁ක≮ឭଏᣇᴺߩౣ᭴▽ࠍଦㅴߔࠆߣ޿߁PbRߩ⁓޿ߣ৻⽾ᕈࠍᰳߊߎߣ߆ࠄ㧘
2005ᐕᐲ߆ࠄ᧪㒮㧔Attendance㧕න૏߳ᄌᦝߐࠇߚ㧔DH, 2004㧕‫ޕ‬ߎ߁ߒߚᄌᦝߦߪ㧘ේଔ⸘▚⋡⊛ߩ㆑޿ߦࠃࠆ⸘▚ᣇᴺߩᄌᦝߩᔅⷐᕈߣ޿߁ේଔ⸘▚਄ߩၮᧄේℂ߇⷗ࠄࠇࠆ‫ ߜࠊߥߔޕ‬80 ᐕઍએ㒠ߩฦ∛㒮ߢߩౝㇱ⚻༡▤ℂ⋡⊛߿ 90 ᐕઍߩౝㇱᏒ႐ߦ߅ߌࠆฦ࿾ၞߢߩ
ᄾ⚂ਥ૕㑆ߢߩᄾ⚂ଔᩰ੤ᷤ⋡⊛ߦ߅޿ߡߪ㧘ฦ∛㒮ߦ߅޿ߡ HRG ᵴേ㊂ߩ᷹ቯᴺ߇ FCE ߢ޽ࠇ Spellߢ޽ࠇ㧘߹ߚ FCE ߩᢙ߃ᣇ߇⇣ߥߞߡ޿ࠃ߁ߣ㧘ฦ∛㒮ౝ෸߮ᄾ⚂ਥ૕㑆ߢߤ߁᷹ቯߔࠆ߆ߩቯ⟵߇౒৻ᣇ㧘ห৻ Spell ౝߩⶄᢙߩ FCE ߇⇣ߥࠆ HRG ߢ޽ࠆ႐วߦߪ㧘ᡰ㈩⊛㧔dominant㧕HRG ࠍ᳿ቯߔࠆ‫ޕ‬2005 ᐕᐲ߆ࠄߪᦨ߽㜞޿ଔᩰࠍᓧࠄࠇࠆ HRG ߇ᡰ㈩⊛ HRG ߣߐࠇࠆ‫ߒߛߚޕ‬㐳ᦼ⊛ߦߪ Spell ߣࠤࠕࡄࠬߦኻᔕߒߚ HRG4.0 ߇㐿⊒ߐࠇࠆߚ߼㧘ᡰ㈩⊛ HRG ࠍ↪޿ࠆߎߣߦࠃࠆਇᱜ⏕ᕈߩ໧㗴ߪ⸃᳿ߐࠇࠆߎߣߦߥࠆ㧔DH, 2004㧕
‫ޕ‬

13)

㧙㧙

ࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿᦭ߐࠇߡ޿ࠇ߫໧㗴ߪߥ޿‫ ߒ߆ߒޕ‬97 ᐕᐲએ㒠ߩෳᾖේଔ೙ᐲߦࠃࠆࡌࡦ࠴ࡑ࡯ࠢ⋡⊛߿ 2003 ᐕᐲએ㒠
ߩ PbR ਅߦ߅ߌࠆ࿖ቯଔᩰ⸳ቯ⋡⊛ߩߚ߼ߦߪ㧘∛㒮㑆ߢ⇣ߥࠆ⸘▚ᣇᴺ㧔HRG න૏㊂ߩ᷹ቯᴺ㧕߇ขࠄࠇࠆߣ㧘
HRG ේଔߩ∛㒮㑆Ყセ߿ HRG ߩో∛㒮ᐔဋේଔߩ▚಴߇ା㗬ᕈߩ⭯޿߽ߩߣߥߞߡߒ߹߁‫ޕ‬ߘߎߢේଔ⸘▚⋡⊛ߩᄌൻߦวࠊߖߡේଔ⸘▚ኻ⽎ߩන૏ᢙߩ᷹ቯᴺࠍ∛㒮㑆ߩ⛔৻߇ߣࠅ߿ߔ޿߽ߩ߳
ߣᄌᦝߒߚߩߢ޽ࠆ‫ޕ‬
4.3. ᮡḰൻߐࠇߚ࿖ኅේଔ⸘▚࠰ࡈ࠻ߩน⢻ᕈߩᬌ⸛଻ஜ⋭ߪ㧘ේଔ㈩⾮ᴺߩ⛔৻ᕈࠍᒝൻߔࠆߚ߼㧘ᮡḰൻߐࠇߚ࿖ኅේଔ⸘▚ࡕ࠺࡞ߩ᭴▽࡮೑↪ߩᬌ⸛ࠍឭ᩺ߒߡ޿ࠆ‫଻ߚߒ࡯ࡘࡆ࠲ࡦࠗޕ‬ஜ⋭ෳᾖේଔᜂᒰቭߦࠃࠇ߫㧘ࠃࠅౕ૕⊛ߦߪ㧘ᚻᴺ߇⛔৻ߐࠇߚන৻ߩේଔ⸘▚ࠦࡦࡇࡘ࡯࠲࠰ࡈ࠻࠙ࠚࠕߩߎߣߢ޽ࠆ‫ޕ‬ᄙ᭽ߥ⸃㉼߿∛㒮ⵙ㊂ߩ૛࿾ߩ޽ࠆේଔ⸘▚ࡑ࠾ࡘࠕ࡞ߣߪ⇣ߥࠅ㧔⨹੗, 2006a,b,c㧕㧘ߎߩᮡḰ࠰ࡈ࠻ߦࠃࠇ߫⾌⋡೎⋥⺖࡮㈩⾮࡞࡯࡞߿ࠦࠬ࠻ࡊ࡯࡞
⸳ቯ㧘㈩⾮ၮḰࡌ࡯ࠬ㧘ㇱ㐷㑆ේଔ㈩⾮ᣇᴺߥߤේଔ㈩⾮ᣇᴺࠍቢోߦ⛔৻ൻߔࠆߎߣ߇น⢻ߦߥࠆ‫ߎޕ‬߁ߒߚᮡḰൻߐࠇߚ࿖ኅේଔ⸘▚࠰ࡈ࠻ߪ㧘଻ஜ⋭ߦߣߞߡߘߩ㐿⊒࡮⛽ᜬߪ㜞ߊ߿ߞ߆޿ߥ߽ߩߦߥࠅ
߁ࠆ߇㧘ේଔ⸘▚ᣇᴺߩ⛔৻ᕈࠍ଻㓚ߒ㧘࠺࡯࠲ߩ⾰߳ߩߒߞ߆ࠅߣߒߚࠕࡊࡠ࡯࠴߇ขࠇࠆߚ߼㧘ᮡḰൻේଔ⸘▚࠰ࡈ࠻ߩㆡุߦߟ޿ߡߩ⷗⸃ࠍតߒߡ޿ࠆߣ޿߁㧔DH, 2003b㧕‫ޕ‬଻ஜ⋭ߩෳᾖේଔᜂᒰቭߦࠃࠇ߫㧘⃻࿷ߪ㧘ේଔ⸘▚ߩߚ߼ߦ೑↪ߔߴ߈࠰ࡈ࠻ߦߟ޿ߡߩ⸥ㅀߪ߹ߞ
ߚߊߥߊ㧘ฦ␠߇ឭଏߒߡ޿ࠆ࠰ࡈ࠻ߩਛ߆ࠄฦ∛㒮߇⥄↱ߦㆬᛯߒߡ೑↪ߒߡ޿ࠆ‫଻ޕ‬ஜ⋭ߣߒߡߪߤ
ߩળ␠ߩ࠰ࡈ࠻ߦኻߒߡ߽⹺⸽ߪ಴ߒߡ߅ࠄߕ㧘ߘߩේଔ⸘▚ᚻᴺ߽⺞ᩏߒߡ޿ߥ޿ߣ޿߁‫଻ޕ‬ஜ⋭ߣߒߡߪ㧘ฦ࠰ࡈ࠻ߩ⺞ᩏߣ࠰ࡈ࠻ળ␠߳ߩᡷༀଐ㗬߿࠰ࡈ࠻߳ߩ⹺⸽ߥߤࠍߔࠆߣ㕖Ᏹߦᄢ߈ߥ⽿છࠍ᦭ߔࠆߎߣߦߥࠅ㧘ߘࠇߛߌߩ੺౉ࠍߔࠆ߆ࠄߦߪㅊട⊛ߥ⾗Ḯ߇ᔅⷐߦߥࠆߚ߼㧘ߘߎ߹ߢߪߒߡ޿ߥ޿ߣ
ߒߡ޿ߚ‫଻ߚ߹ޕ‬ஜ⋭ߣߒߡߪ㧘ታᘒߪߣ߽߆ߊ㧘޽ߊ߹ߢ߽ෳᾖේଔ೙ᐲߪ NHS ฦᯏ㑐ߩߚ߼ߩฦᯏ
㑐ߦࠃࠆข⚵ߺߢ޽ࠅ㧘଻ஜ⋭ߪฦᯏ㑐߇⥄ࠄ෼㓸⸘▚ߒߚ࠺࡯࠲ࠍขࠅ߹ߣ߼ߡᖱႎឭଏߔࠆᡰេᵴേ
ࠍߒߡ޿ࠆߦߔ߉ߥ޿ߣ޿߁ၮᧄࠬ࠲ࡦࠬߢ޽ࠆߚ߼㧘ㆊᐲߩේଔ⸘▚ᣇᴺ߳ߩ੺౉ߪᗧ࿑⊛ߦㆱߌߡ޿
ࠆߣߒߡ޿ߚ‫ޕ‬߽ߞߣ߽࠰ࡈ࠻ળ␠ߩ NHS ะߌෳᾖේଔ⸘▚↪࠰ࡈ࠻ࠍ૶ߞߡ޿ࠆߣ޿ߞߡ߽㧘ฦ⾌⋡ߩ⋥ធ࡮㑆ធ࡮
▤ℂ⾌඙ಽ߿ᄌേ࡮Ḱ࿕ቯ࡮࿕ቯ⾌඙ಽ㧘ࠦࠬ࠻ࡊ࡯࡞⸳ቯ㧘㈩⾮ၮḰࡌ࡯ࠬㆬᛯ㧘⾗Ḯࡊࡠࡈࠔࠗ࡞਄
ߩ㜞ଔ㗄⋡ㆬᛯߥߤߪฦ∛㒮ߢታᣉߐࠇߡ޿ࠆߚ߼㧔⨹੗, 2006c㧕
㧘࠰ࡈ࠻ળ␠ߩឭଏߒߡ޿ࠆߩߪේଔ
⸘▚ߩᄢᨒߦㆊ߉ߥ޿‫߼ߚߩߘޕ‬઒ߦ৻ߟߩ NHS ะߌේଔ⸘▚࠰ࡈ࠻ߦ⹺⸽ࠍਈ߃ߚߣߒߡ߽㧘ߘࠇߪ㧘଻ஜ⋭߇ߘߩน⢻ᕈࠍᬌ⸛ߒߡ޿ࠆ㧘⾌⋡ಽ㘃߿㈩⾮ᣇᴺࠍߒߞ߆ࠅߣᮡḰൻߒߚ࿖ኅේଔ⸘▚࠰ࡈ࠻ߣߪᕈᩰ߇⇣ߥࠆ‫ޕ‬଻ஜ⋭ߪ㧘ᮡḰൻߐࠇߚ࿖ኅේଔ⸘▚࠰ࡈ࠻ߩน⢻ᕈࠍᬌ⸛ߒߚ߇㧘⚿ዪߩߣߎࠈ㧘ߘߩ዁᧪⊛น⢻ᕈࠍឃ㒰ߒߡߪ޿ߥ޿߽ߩߩ㧘ᒰ㕙ߪߎߩࠃ߁ߥ઀⚵ߺߩዉ౉ࠍ⷗ㅍߞߚ‫ޕ‬
4.4. ⽶ᜂシᷫߩߚ߼ߩઍᦧ⊛ේଔ⸘▚೙ᐲߩᬌ⸛
଻ஜ⋭ߪ㧘⃻࿷ߩ࿖ቯଔᩰ⸳ቯᣇᑼߪో∛㒮ߩቢోߥේଔ࠺࡯࠲ᛠីߦၮߠ޿ߡ޿ࠆߚ߼㜞ߊߟߊߩߢ㧘዁᧪⊛ߦߪේଔ⸘▚⽶ᜂࠍシߊߔࠆᰴߩࠃ߁ߥઍᦧ᩺ࠍᬌ⸛ߔߴ߈ߣߒߡ޿ࠆ㧔DH, 2003b㧕‫ޕ‬Ԙ ߔߴߡߩࠨ࡯ࡆࠬಽ㘃ࠣ࡞࡯ࡊࠍ✂⟜ߔࠆߚ߼ߩ੤ઍᣇᑼߢߩࠨࡦࡊ࡞ᚻᴺߩᵴ↪
ԙ ⾰ߩ㜞޿ේଔ⸘▚ࠪࠬ࠹ࡓࠍ᦭ߔࠆ޿ߊߟ߆ߩ∛㒮ߢ▚಴ߐࠇߚේଔߦଐሽԚ ේଔ⸘▚߳ⷙ▸⊛ࠕࡊࡠ࡯࠴ࠍዉ౉ߒ㧘ᦨ⦟ߩ⸻≮ᣇᴺߣ਄⸥ߩԘ෸߮ԙߩᣇᴺߦࠃࠆ࠺࡯࠲
㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

ࠍ߽ߣߦ࿖ኅᮡḰේଔ⸘▚ࠍ೑↪
߹ߚ଻ஜ⋭ෳᾖේଔᜂᒰቭ߳ߩࠗࡦ࠲ࡆࡘ࡯⺞ᩏߦࠃࠇ߫㧘Ԙߩࠨࡦࡊ࡞ᚻᴺߣߒߡߪᰴߩ 3 ߟߩᣇᴺ
߇ᗐቯߐࠇࠆߣ޿߁‫ޕ‬Ԙ ో࠺࡯࠲ឭ಴ߩߚ߼ߦ㧘∛㒮ࠍࠨࡦࡊ࡞ߔࠆᣇᴺԙ ో∛㒮ࠍኻ⽎ߦ㧘ࠨࡦࡊ࡞ߒߚ⸻≮⑼ࠨ࡯ࡆࠬߩో࠺࡯࠲ࠍឭ಴ߔࠆᣇᴺԚ ࠨࡦࡊ࡞∛㒮ࠍኻ⽎ߦ㧘ࠨࡦࡊ࡞ߒߚ⸻≮⑼ࠨ࡯ࡆࠬߩో࠺࡯࠲ࠍឭ಴ߔࠆᣇᴺ
∛㒮ࠍࠨࡦࡊ࡞ߔࠆᣇᴺߣේଔ⸘▚ኻ⽎ࠨ࡯ࡆࠬࠍࠨࡦࡊ࡞ߔࠆᣇᴺߣߘߩਔ⠪ࠍࠨࡦࡊ࡞ߔࠆᣇᴺߩ 3 ㅢࠅ߇ᗐቯߐࠇߡ޿ࠆ߇㧘ኻ⽎ࠨ࡯ࡆࠬߩ㑐ㅪ࠺࡯࠲ࠍࠨࡦࡊ࡞ߔࠆᣇᴺ㧔ᣣᧄߩ⺞ᩏߦ⷗ࠄࠇࠆ․ቯ᦬ߩ࠺࡯࠲ߩߺߩᵴ↪ߥߤ㧕ߪᗐቯߐࠇߡ޿ߥ޿‫ޕ‬ߒ߆ߒ଻ஜ⋭ߪ㧘ᒝ࿕ߥ࿖ቯଔᩰ⸳ቯࠍḩߚߔߚ߼ߦᔅⷐߥⷐ⺧ߣฦ∛㒮ߢߩ⚻༡▤ℂߦㆡಾߥᖱႎࠍ
ឭଏߔࠆߚ߼ߦᔅⷐߥⷐ⺧ߣߩࡃ࡜ࡦࠬࠍ⠨߃ߡ㧘ઍᦧ᩺ߩ዁᧪⊛ߥណ↪ࠍ੹ᓟ߽ᬌ⸛ߔࠆߣߒߟߟ߽㧘ᒰ㕙ߪో∛㒮࡮ోࠨ࡯ࡆࠬߩో࠺࡯࠲ߦၮߠߊේଔ⸘▚೙ᐲࠍ⛽ᜬߔࠆߣߒߚ‫ޕ‬㧡㧚ේଔ⸘▚⋙ᩏߩᒝൻ࡮౏ᑼൻ
ᓥ᧪ߩࡌࡦ࠴ࡑ࡯ࠢ⋡⊛ਛᔃߩෳᾖේଔ೙ᐲߦ߅޿ߡ߽㧘ේଔ⸘▚ᣇᴺߩ⛔৻ᕈߪᲧセน⢻ᕈߩὐ߆ࠄ
㊀ⷐߢ޽ࠅ㧘ߘࠇࠁ߃ේଔ⸘▚⋙ᩏ߽޽ࠆ⒟ᐲߪታᣉߐࠇߡ߈ߚ‫ ߒ߆ߒޕ‬PbR ೙ᐲਅߢߪේଔ⸘▚⚿ᨐ߇
⾗㊄ଏ⛎ߣ࡝ࡦࠢߔࠆߚ߼ߦ㧘⃻႐∛㒮߇ේଔ⸘▚ᣇᴺߦኻߒߡ੹߹ߢએ਄ߦᢅᗵߦߥߞߡ߅ࠅ㧘ේଔ⸘▚ᣇᴺߩ⛔৻ൻ߇⃻႐㑐ଥ⠪ߩ⚊ᓧᕈߣ޿߁ⷰὐ߆ࠄᭂ߼ߡ㊀ⷐߦߥߞߡ߈ߚ‫ߚ߹ޕ‬ᐔဋේଔࠍࡌ࡯ࠬߦ
࿖ቯଔᩰ߇᳿ቯߐࠇࠆߚ߼ߦ㧘ᚻᴺߩ⛔৻ᕈ⏕଻ߣ޿߁ὐ߆ࠄߪ߽ߜࠈࠎߩߎߣ㧘ේଔᖱႎߩା㗬ᕈ⏕଻/ᠲ૞㒐ᱛߩߚ߼ߦ߽ේଔ⸘▚ߩࡑ࠾ࡘࠕ࡞Ḱ᜚ᕈࠍ⋙ᩏߔࠆߎߣߩ㊀ⷐᕈ߇㜞߹ߞߡ߈ߚ‫ޕ‬ߘߎߢ଻ஜ⋭ߪ㧘ᣢሽߩቯ⟵߿ࠟࠗ࠼࡜ࠗࡦ߇∛㒮㑆ߢ৻⽾ᕈࠍ߽ߞߡㆡ↪ߐࠇࠆࠃ߁ߦߔࠆߚ߼ߣ㧘∛㒮㑆ߩਇ৻⥌ࠍㆱߌࠆߚ߼ߦࠃࠅߒߞ߆ࠅߣ⸥ㅀߔߴ߈ቯ⟵/ࠟࠗ࠼࡜ࠗࡦ㗔ၞࠍ᣿⏕ߦߔࠆߚ߼ߦ㧘ᄖㇱ⋙ᩏੱߚࠆ Audit Commission ߦଐ㗬ߒߡ㧘࠺࡯࠲⋙ᩏ߿ෳᾖේଔߩ⹦⚦ߥ⋙ᩏࠍ฽߻৻ㅪߩข⚵ߺࠍߒߡ߈ߚ㧔DH, 2003a㧕
‫ ߚ߹ޕ‬2003 ᐕᐲߩᧄᩰ⊛ߥේଔ⸘▚⋙ᩏએ㒠߽㧘⋧ኻ⊛ߦ◲ᤃߥ߽ߩߢ޽ࠆ߽ߩ
ߩ㧘2004 ᐕᐲ෸߮ 2005 ᐕᐲ߽ේଔ⸘▚ߦ㑐ࠊࠆ⋙ᩏࠍ Audit Commission ߦଐ㗬ߒ⛯ߌߡ߈ߚ‫ߦࠄߐޕ‬ࠗࡦ࠲ࡆࡘ࡯ߒߚ଻ஜ⋭ෳᾖේଔᜂᒰቭߦࠃࠇ߫㧘2005 ᐕ 5 ᦬⃻࿷㧘ේଔ⸘▚⋙ᩏߩ౏ᑼൻࠍ Audit
Commission ߣද⼏ਛߢ㧘዁᧪⊛ߦߪ⛮⛯⊛ߥ߽ߩߦߥࠆߩߢߪߥ޿߆ߣߒߡ޿ߚ‫ޕ‬ߎ߁ߒߚේଔ⸘▚⋙ᩏߩᧄᩰൻߩᵹࠇߪ㧘ෳᾖේଔ 2005 ෼㓸ࠟࠗ࠳ࡦࠬ㧔DH, 2004㧕ߦ߅ߌࠆౣਃߦ
ࠊߚࠆේଔ⸘▚⋙ᩏ㊀ⷞߩ⸥ㅀ߆ࠄ߽᣿ࠄ߆ߢ޽ࠆ‫ޕ‬DH㧔2004㧕ߦߪ㧘‫ࡓ࡜ࠣࡠࡊߩ⸽⹺ߣ⾰ߩ࠲࡯࠺ޟ‬߇ขࠅ⚵߹ࠇߡ߅ࠅ㧘ߎࠇߪߐࠄߥࠆਛᄩߦࠃࠆ࠺࡯࠲⾰࠴ࠚ࠶ࠢߣ Audit Commission ߩ⋙ᩏࡊࡠࠣ࡜
ࡓ߳ߩෳᾖේଔߩ⚵ߺㄟߺߦࠃࠅ⵬ቢߐࠇ⛯ߌࠆ‫ޕ‬
㧔p.5㧕
‫ޠ‬
‫ޟ‬2005 ᐕ߽⋙ᩏᵴേࠍ⛮⛯ߔࠆߩߢ㧘ේଔ㈩⾮ߦ߅޿ߡߥߐࠇߚᗧᕁ᳿ቯ෸߮ࡊࡠ࠮ࠬߪ㒐ᓮน⢻ߢ޽ࠆߎߣ߇᳿ቯ⊛ߦ㊀ⷐߢ޽ࠆ‫ޕ‬㧔p.66㧕
‫ޠ‬‫⋙ޟ‬ᩏ⋡⊛
ߩߚ߼ߦ㧘ෳᾖේଔ߆ࠄᦨ⚳⊛ߥ⽷ോൊቯ߳ߩ⺞๺ࡊࡠ࠮ࠬߩ⹦⚦ࠍឭଏߔࠆᔅⷐ߇޽ࠆ‫ޕ‬㧔p.66㧕
‫ޠ‬‫ߦ․ޟ‬ᣢሽߩࠟࠗ࠳ࡦࠬߣ⇣ߥࠆߎߣࠍ઻߁႐วߦߪ㧘ߥߐࠇߚᗧᕁ᳿ቯߩߔߴߡࠍ⋙ᩏ⋡⊛ߩߚ߼ߦᢥᦠൻߔ
ߴ߈ߢ޽ࠆߎߣࠍផᅑߔࠆ㧔p.66㧕
‫ߚߞ޿ߣޠ‬ෳᾖේଔ⸘▚⋙ᩏ㊀ⷞߩ⸥ㅀ߇⷗ࠄࠇࠆ‫ࠬࡦ࠳ࠗࠟߚ߹ޕ‬㧔DH, 2004㧕ߩ౨㗡ߦ߅޿ߡ߽㧘PbR ਅߢߩ࿖ቯଔᩰ⸳ቯߦ૶߁ߚ߼ߦෳᾖේଔ࠺࡯࠲ߪ⾰߇㜞ߊᱜ⏕ߢ޽ࠆߎߣ߇㊀ⷐߢ޽ࠅ㧘ෳᾖේଔ࠺࡯࠲ߩ⾰ߣᱜ⏕ᕈ߳ߩᄖㇱ⋙ᩏੱ෸߮ Audit Commission ߦࠃࠆᒝ޿㑐ᔃߪ⛮⛯ߔࠆߣ੍᷹ߐࠇࠆ㧘ߣ⋙ᩏߩⷞὐࠍᒝ⺞ߒߡ޿ࠆ㧔p.4㧕
‫ޕ‬ߥ߅ Audit Commission ߦࠃࠆේଔ⸘▚⋙ᩏߪ߹ߛᐕᰴߩ߽ߩߣߒߡ⏕┙ߒߡ޿ߥ޿߇㧘ෳᾖේଔᜂᒰ
㧙㧙

ࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿ቭߦࠃࠇ߫㧘৻࿁ᧄᩰ⊛ߦߒߚߩߢߒ߫ࠄߊߪฦᯏ㑐߳ߩ‧೙ᯏ⢻ߪ௛ߊߢ޽ࠈ߁ߣߒߡ޿ߚ‫ߎߒߛߚޕ‬ߩ޽ߚࠅߦߪࠗࡦ࠲ࡆࡘ࡯ߒߚ⃻႐∛㒮ߩෳᾖේଔᜂᒰ⠪ߩ⋙ᩏߦኻߔࠆ⠨߃ᣇߣߩࠡࡖ࠶ࡊ߇ᗵߓࠄࠇ
ࠆ‫∛ޕ‬㒮ߩෳᾖේଔᜂᒰ⠪ߪ㧘⃻⁁ߩෳᾖේଔ⋙ᩏߪ㧘⴫㕙⊛㧘ㇱಽ⊛ߢ޽ࠅ㧘߹ߚ∛㒮ߦࠃߞߡ⇣ߥࠆ
ේଔ㈩⾮ᣇᴺߩㆡಾᕈߪߘߩ∛㒮ߩੱߢߥ޿ߣࠃߊߪࠊ߆ࠄߕ㧘ᣢሽߩᣇᴺ߇⃻⁁ߩᖱႎࠪࠬ࠹ࡓⅣႺਅ
ߢߪࡑ࠾ࡘࠕ࡞ߩᣇᴺࠃࠅ߽ࠃ޿ᣇᴺߢ޽ࠆߣ⃻႐ߩේଔ⸘▚ᜂᒰ⠪߇޿߃߫㧘ߥ߆ߥ߆෻⺰ߢ߈ߥ޿ߢ
޽ࠈ߁ߣߒߡ޿ߚ㧔⨹੗, 2006c㧕
‫ޕ‬ේଔ⸘▚ࡑ࠾ࡘࠕ࡞਄ߩᣇᴺߪෳ⠨ߣߒߡߩᦨዊ㒢ᓥ߁ߴ߈ᮡḰߦㆊ߉ߥ޿ߣ⃻႐ᜂᒰ⠪ߪ⹺⼂ߒߡ߅ࠅ㧘ᧄᒰߦࠃࠅࠃ޿ᣇᴺߢ޽ࠆ߆ߤ߁߆ࠊ߆ࠄߥ޿⁁ᴫߢ㧘⃻ታߦߪ㧘ฦ∛㒮ߩㇺวߦวࠊߖߡ߆ߥࠅ⥄↱ߦ⁛⥄ߩᣇᴺߢේଔ⸘▚߇ߥߐࠇߡ޿ࠆ‫ޕ‬એ਄ߩࠃ߁ߥ଻ஜ⋭ߦࠃࠆේଔ⸘▚⋙ᩏߩᧄᩰൻ࡮౏ᑼൻឭ᩺ߦኻߒߡߪ㧘߶ߣࠎߤߩ⃻႐㑐ଥ⠪߇⢐ቯ⊛ߢ޽ࠆ‫ޕ‬ේଔ⸘▚⋙ᩏߪߔߢߦᄖㇱ⋙ᩏੱ߳ߩઃ⸤੐㗄ߢ޽ࠅ㧘ో⥸ߦᄖㇱ⋙ᩏ⾌↪߽ᣢߦჇടߒߡ
޿ࠆߩߢ޽ࠆ߆ࠄ㧘PbR ዉ౉ߦࠃࠆ⽷ോ࡝ࠬࠢߩჇടߦวࠊߖߡ⋙ᩏⷙᮨࠍ᜛ᄢߔߴ߈ߢ޽ࠆߣߩᜰ៰߇
⷗ࠄࠇࠆ‫⋙ޕ‬ᩏੱ߇ㆡಾߥ⎇ୃࠍฃߌࠆߥࠄ߫ 14)㧘⃻࿷એ਄ߦ⋙ᩏߦᄢ߈ߥఝవࠍਈ߃ࠆߎߣߪࠃ޿ߎߣ
ߢ޽ࠆߣߔࠆ⃻႐㑐ଥ⠪߽޿ࠆ‫ߚ߹ޕ‬ห௥ክᩏߦၮߠ޿ߚ౏ᑼߥ⋙ᩏߦኻߔࠆઍᦧ᩺߿㧘⎇ୃ߿⚻㛎ߩ౒᦭ߢᡰេߔࠆߚ߼ߦ⡯ຬࠍ⍴ᦼ㑆㈩⟎឵߃ߔࠆ᩺ࠍ␜ໂߔࠆ⠪߽޿ߚ‫ߦࠄߐޕ‬ක≮ಽ㊁ߩ⋙ᩏߦߪ㧘NHSฦᯏ㑐ౝߦ߅ߌࠆౝㇱ⋙ᩏߣ Audit Commission ਥዉߩᄖㇱ⋙ᩏ㧘Healthcare Commission15)ߦࠃࠆḰᄖㇱ⊛ߥ⋙ᩏ⊛⺞ᩏ߇޽ࠆ߇㧘ߎࠇࠄฦ⒳⋙ᩏߘࠇߙࠇߩᓎഀࠍࠃࠅ᣿⏕ߦߔࠆߎߣߦࠃߞߡ㧘⋙ᩏߩ౏ᑼൻ߇ㅴ߻ߣ⠨߃ࠆ㑐ଥ⠪߽޿ࠆ‫ޕ‬ᄖㇱ⋙ᩏߦߟ޿ߡߪ㧘⥄ࠄ⋙ᩏੱࠍᜰฬߢ߈ࠆ Foundation ∛㒮ࠍ㒰ߊోߡߩ∛㒮ߦኻߒߡ㧘Audit
Commission ߇⋙ᩏੱࠍᜰฬߒ㧘Audit Commission ⥄り߆ᄖㇱߩળ⸘⋙ᩏᴺੱߦࠃࠅߥߐࠇࠆ‫ޕ‬NHS ߩ
⽷ോ▤ℂߦ⹦ߒ޿ Ellwood ߦࠃࠇ߫㧘⃻⁁ߢߪ㧘3 ಽߩ 2 ߪ Audit Commission ⥄りߩක≮ಽ㊁ߩ⋙ᩏੱߦࠃࠅߥߐࠇ㧘ᱷࠅ 3 ಽߩ 1 ߪ᳃㑆ߩળ⸘⋙ᩏᴺੱߦࠃࠅߥߐࠇߡ޿ࠆߣ޿߁‫଻ߚ߹ޕ‬ஜ⋭ෳᾖේଔᜂᒰ
ቭߦࠃࠇ߫㧘
ᄖㇱ⋙ᩏႎ๔ᦠߥߤᄖㇱ⋙ᩏᬺോߩߔߴߡߪߘߩᄖㇱ⋙ᩏੱߩฬߩਅߢታᣉ࡮૞ᚑߐࠇࠆ߇㧘ߘߩᄖㇱ⋙ᩏߪ Audit Commission ߦࠃࠅ⸳ቯߐࠇߚᨒ⚵ߺߩ߽ߣߢߔߴߡߥߐࠇࠆ‫ ߚ߹ޕ‬Audit
Commission ߪ NHS ฦᯏ㑐ߩ⽷ോ▤ℂߣળ⸘⋙ᩏߦ⽿છ߇޽ࠅ㧘නߦ⋙ᩏࠍߔࠆߛߌߢߥߊ⽷ോ▤ℂో⥸ߦ߽⽿છࠍ᦭ߒߡ޿ࠆߣߒߡ޿ߚ‫ޕ‬৻ᣇ㧘Ḱᄖㇱ⊛ߥ⋙ᩏ⊛⺞ᩏᬺോߦ㑐ߒߡߪ㧘NHS ߩฦ⒳ⷙ೙ᯏ㑐߇㑐ଥߒߡ߈ߚ߇㧘଻ஜ⋭ෳᾖේଔᜂᒰቭߦࠃࠇ߫㧘⃻࿷ߢߪⷙ೙ᯏ㑐ߩ㑆ߢදቯ߇⚿߫ࠇ㧘Healthcare Commission㧔HC㧕߇ਥⷐߥ NHS
ⷙ೙ᯏ㑐ߣߒߡⷙ೙ߩᢛℂ߇ߥߐࠇߡ޿ࠆߣ޿߁‫ ߩߎޕ‬HC ߦࠃࠆ⋙ᩏߪ◲නߥ߽ߩߢ㧘ᧄᩰ⊛ߥ⋙ᩏߪ
Audit Commission ߦࠃࠆ߽ߩߛߌߢ޽ࠆߣ޿߁‫ޕ‬ේଔ⸘▚⋙ᩏ૕೙ߩ౏ᑼൻߦኻߔࠆ⃻႐㑐ଥ⠪߆ࠄߩ⢐ቯ⊛ߥ෻ᔕߦኻߒߡ㧘଻ஜ⋭ߪ㧘ේଔ⸘▚ⷙቯ߳ߩㆩ቞ࠍ฽߻⻉⺖㗴ߦߟ޿ߡ Audit Commission ߣද⼏ਛߢ޽ࠅ㧘ේଔ⸘▚⋙ᩏߦ㑐ߔࠆࠃࠅ౏ᑼ⊛ߥ᭴ㅧࠍᜬߟߎߣߪࡔ࡝࠶࠻߇޽ࠆߣ⠨߃ߡ޿ࠆߣ࿁╵ߒߡ޿ࠆ㧔DH, 2003a㧕
‫ޕ‬PbR ߩᧄᩰㆇ↪ߦะߌߡේଔ⸘▚⋙ᩏߩ㊀ⷐᕈߪ㜞߹ߞߡ޿ࠆߚ߼㧘2004 ᐕᐲߩ⋙ᩏ↪⾗Ḯ㧔੍▚㧕ߪ೨ㅴߔࠆߚ߼ߩᦨዊ㒢ߩ⸵ኈ࡟ࡌ࡞ߣ⠨߃ߡ޿ࠆߣㅀߴ㧘੹ᓟߐࠄߦ⋙ᩏ↪ߦ⾗Ḯࠍഀࠅᒰߡߡ޿ߊߎߣࠍ␜ໂߒߡ޿ࠆ‫ߚ߹ޕ‬ห௥

14)ߎ߁ߒߚ᧦ઙ߇ߟߌࠄࠇࠆ⢛᥊ߦߪ㧘ේଔ⸘▚⋙ᩏߦ㑐ߔࠆᄖㇱ⋙ᩏੱߩ⢻ജߦኻߔࠆ⃻႐ක≮ᯏ㑐ߩ⇼ᔨ߇޽ࠆ‫ޕ‬ዋߥߊߣ߽ේଔ⸘▚⋙ᩏߦ㑐ߔࠆ㒢ࠅ㧘߹ߛᄖㇱ⋙ᩏੱߩ⚻㛎ߪᵻߊ㧘ᡷༀߩ૛࿾߇ᄢ߈޿ߣ⠨߃ࠄࠇߡ޿ࠆ㧔⨹੗, 2006c㧕
‫ޕ‬ᣣᧄߢߪ߹ߛႎ๔ේଔ⸘▚೙ᐲ߇੐ታ
਄ߥ޿⁁ᴫߢ޽ࠆߚ߼㧘∛㒮ේଔ⸘▚ߩ⋙ᩏੱߩ⾰࡮⢻ജߦ㑐ߔࠆ⼏⺰ߪᒰὼߥ޿߇㧘ႎ๔ේଔ⸘▚ࠍዉ౉ߔࠆ႐วߦߪ㧘⋙ᩏ೙ᐲࠍวࠊߖ
ߡዉ౉ߔࠆᔅⷐ߇޽ࠆߣߣ߽ߦ㧘ߘߩ⋙ᩏੱߩ⢒ᚑ߽ᄢಾߦߥߞߡߊࠆ‫ޕ‬15) ෳᾖේଔᜂᒰቭߦࠃࠇ߫㧘ᒰ⋙ᩏ⊛⺞ᩏᬺോᜂᒰ⚵❱ߦ㑐ߒߡߪ㧘CHI㧔Commission of Health Improvement㧕߆ࠄ CHAI㧔Commissionfor Healthcare Audit and Inspection㧕
㧘CHAI ߆ࠄ Healthcare Commission ߳ߣ⚵❱ᄌᦝߐࠇߡ޿ࠆ‫ޕ‬㧙㧙

ળ⸘ᬌᩏ⎇ⓥ No.34㧔2006.9㧕

ክᩏߦࠃࠆઍᦧߣ޿߁⃻႐㑐ଥ⠪߆ࠄߩ᩺ߦኻߒߡߪ㧘ේଔ⸘▚ߩห௥ክᩏࠍ⟵ോൻߔࠆߟ߽ࠅߪߥ޿߇㧘ฦ∛㒮߇ࠦ࡯࠼ൻ᳓Ḱࠍะ਄ߐߖߚࠅ⾰ࠍ଻⸽ߒߚࠅߒࠃ߁ߣߔࠆߚ߼ߩ৻ߟߩㆬᛯ⢇ߣߒߡห௥ክᩏߦ
ᦼᓙࠍᜬߞߡ޿ࠆߣߔࠆߣߣ߽ߦ㧘ห௥ክᩏࠍ⋙ᩏߩઍᦧ╷ߣߪ⠨߃ߥ޿ߣ᣿⏕ߦㅀߴߡ޿ࠆ‫ޕ‬߹ߚᖱႎߩ⾰ߦ㑐ߒߡߪ㧘NHS ߩᖱႎ㑐ㅪߩ▤ℂᯏ㑐ߢ޽ࠆ Health and Social Care Information
Centre ߦࠃࠆᖱႎߩ⾰଻⸽ࡊࡠ࠮߽ࠬ㧘∛㒮߇⥄ࠄߩ࠺࡯࠲ߩ⾰ࠍ৻⽾ᕈ࡮ㆡᤨᕈ࡮൮᜝ᕈߩⷰὐ߆ࠄ᷹
ቯߔࠆߎߣࠍน⢻ߦߒߡ߅ࠅ㧘ߎߩᖱႎߪ଻ஜ⋭㧘HC㧘Audit Commission ߣ߽౒᦭ߐࠇߡ޿ࠆߣ޿߁‫ޕ‬ߎߩઁߦ㧘଻ஜ⋭ෳᾖේଔᜂᒰቭߦࠃࠇ߫㧘ෳᾖේଔ෼㓸ࡊࡠ࠮ࠬߩᦨ⚳Ბ㓏ߢ޽ࠆឭ಴Ბ㓏ߢߪ㧘ឭ಴࠺࡯࠲ࠍ࠴ࠚ࠶ࠢߔࠆߚ߼ߦ⸳ቯߐࠇߚࡄ࡜ࡔ࡯࠲࠮࠶࠻ߦࠃࠅ㧘ឭ಴ߐࠇߚෳᾖේଔႎ๔ᦠߩ࠺࡯࠲ߩ
⾰߇⥄േ⊛ߦ⺞ᩏߐࠇ㧘࠺࡯࠲ߩ⾰ႎ๔ᦠ߇૞ᚑߐࠇߡ㧘ฦ∛㒮ߩฦឭ಴ߦኻߒߡࠝࡦ࡜ࠗࡦߢߘߩ⾰ႎ๔ᦠࠍ⷗ࠆߎߣ߇ߢ߈ࠆ઀⚵ߺ߇଻ஜ⋭ߦࠃࠅឭଏߐࠇߡ޿ࠆ‫ޕ‬㧢㧚߅ࠊࠅߦ
ࠗࠡ࡝ࠬක≮⇇ߢߪ㧘ᖚ⠪߳ߩࠃࠅᨵエߢᄙ᭽ߥක≮ឭଏࠍታ⃻ߔࠆߚ߼ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲ߇Ბ㓏⊛ዉ౉ਛߢ޽ࠅ㧘ේଔ⸘▚೙ᐲ߇ߎߩ೙ᐲࠍᡰ߃ߡ޿ࠆ‫߼ߚߩߘޕ‬ฦ∛㒮ߢߩේଔ⸘▚ᣇᴺߩ⛔৻ᕈ߿♖ᐲߩะ਄߇⺖㗴ߣߥߞߡ޿ࠆ‫଻ޕ‬ஜ⋭ߪේଔ⸘▚ߩ⛔৻ᕈ࡮♖ᐲ߇ะ਄ߒߟߟ޽ࠆߣᭉⷰⷞߒߡ޿ࠆ߇㧘
Audit Commission ߩ⺞ᩏߦࠃࠇ߫߹ߛ߹ߛᡷༀߩ૛࿾߇ᄢ߈޿ߎߣ߇್᣿ߒߡ޿ࠆ‫଻ޕ‬ஜ⋭ߪ㧘PbR ߩᧄᩰㆇ↪ߦะߌߡ㧘ߐࠄߥࠆ⛔৻ᕈᒝൻࠍ࿑ࠆߚ߼ߦ㧘ේଔ⸘▚ኻ⽎න૏ᢙ᷹ቯᴺߩᄌᦝ߿ᮡḰൻߐࠇߚ࿖ኅේଔ⸘▚࠰ࡈ࠻ߩᬌ⸛ࠍߒߡ߈ߚ‫৻⛔ߚ߹ޕ‬ᕈ⏕଻߿ା㗬ᕈ࡮⚊ᓧᕈ⏕଻ߩߚ߼ߦ㧘ේଔ⸘▚ࡑ࠾ࡘࠕ࡞߳ߩḰ᜚ᕈࠍਛᔃߣߒߚේଔ⸘▚⋙ᩏߩᒝൻ࡮౏ᑼൻߦขࠅ⚵ࠎߢ޿ࠆ‫ޕ‬ߎߩේଔ⸘▚⋙ᩏߦ㓙ߒߡ㊀ⷐߥᓎഀࠍᨐߚߒߡ޿ࠆߩߪ㧘National Audit Office ߩਅߢ㧘․ߦ࿾ᣇ᡽ᐭ෸߮ක≮ಽ㊁╬ߩ⋙ᩏߦਛᔃ⊛ᓎഀࠍ᦭ߔࠆ Audit Commission ߢ޽ࠆ‫଻ޕ‬ஜ⋭⥄りߩᄖㇱᯏ㑐ߢߪߥߊ㧘଻ஜ⋭ߣ⁛┙ߒߚ National Audit Office ਅߩᄖㇱᯏ㑐ߦߎߩ㊀ⷐߥ⋙ᩏᯏ⢻ࠍછߖߡ޿ࠆὐ߇㊀ⷐߢ㧘⋙ᩏߩା㗬ᕈࠍ㜞߼ߡ޿ࠆ‫ޕ‬ᤓ੹㧘ᣣᧄක≮⇇ߦ߅޿ߡ߽㧘ෘ↢ഭ௛⋭㑐ㅪߩ⎇ⓥ⃰߿⺞ᩏ⎇ⓥᆔຬળਥዉߩਅ㧘ේଔ⸽᜚ߦၮߠ޿
ߚ⸻≮ႎ㈽⸳ቯࠍ৻ߟߩਛᔃ⊛ߥ⋡⊛ߣߒߚ㧘∛㒮㑆ߢ౒ㅢߩේଔ⸘▚㧔޿ࠊ߫৻࿖ක≮ឭଏࠪࠬ࠹ࡓ౒
ㅢේଔ⸘▚ࠪࠬ࠹ࡓ㧔⨹੗, 2005㧕㧕ߩዉ౉ታ㛎߇ߥߐࠇߟߟ޽ࠆ‫ࠬ࡝ࠡࠗޕ‬ක≮⇇ߦ߅ߌࠆᐔဋේଔߦၮ
ߠߊ࿖ቯଔᩰࠍ↪޿ߚᡰᛄ೙ᐲਅߩ㧘ේଔ⸘▚ߩ⃻⁁ߣߎߩ೙ᐲߦኻᔕߒߚේଔ⸘▚ߩᮨ⚝߆ࠄ㧘ᣣᧄක≮⇇߇ቇ߱ὐߪᄙ޿㧔⨹੗, 2006d㧕‫ޕ‬ઃ⸥㧦ᧄ⺞ᩏ⎇ⓥߦ㓙ߒߡߪ㧘ࡈࠔࠗࠩ࡯ࡋ࡞ࠬ࡝ࠨ࡯࠴ᝄ⥝⽷࿅߆ࠄഥᚑࠍฃߌߚ‫ޕ‬㧙㧙

ࠗࠡ࡝ࠬක≮⇇ߩᣂߒ޿⾗㊄ଏ⛎೙ᐲࠍᡰ߃ࠆේଔ⸘▚ߩ⃻⁁ߣᣂዷ㐿ෳ⠨ᢥ₂⨹੗⠹ 2001a ‫∛ޟ‬㒮ળ⸘▤ℂታോߩ∛㒮ዻᕈ೎ታᘒ‫↥ޠ‬ᬺ⚻ℂ 61 3 pp.80-88.
⨹੗⠹ 2001b ‫ޟ‬᳃㑆∛㒮ߦ߅ߌࠆળ⸘▤ℂታോߩ⃻⁁㧞㧚⸻≮⑼೎ណ▚▤ℂ‫∛ޠ‬㒮 60 11 pp.975-978.
⨹੗⠹ 2005 ‫ޡ‬ක≮ࡃ࡜ࡦࠬ࠻࡮ࠬࠦࠕࠞ࡯࠼㧦⧷☨ߩዷ㐿ߣᣣᧄߩ᜸ᚢ‫ޢ‬ਛᄩ⚻ᷣ␠.
⨹੗⠹ 2006a ‫ࠬ࡝ࠡࠗޟ‬ක≮⇇ߦ߅ߌࠆේଔ⸘▚ࡑ࠾ࡘࠕ࡞ᡷ⸓ߦࠃࠆᚻᴺ⛔৻ᕈᒝൻߩᬌ⸽‫ޠ‬ડᬺળ⸘58 5).
⨹੗⠹ 2006b ‫ࠬ࡝ࠡࠗޟ‬ක≮⇇ߦ߅ߌࠆෳᾖේଔ೙ᐲਅߩේଔ⸘▚ߩታᘒ㧦∛㒮ේଔ⸘▚ታോߩᄙ᭽ᕈ‫ޠ‬ળ
⸘ 169 5 .
⨹੗⠹ 2006c ‫ࠆߌ߅ߦࠬ࡝ࠡࠗޟ‬ෳᾖේଔ೙ᐲਅߩ∛㒮ේଔ⸘▚ߩታᘒ㧦੐଀⎇ⓥ‫↥ޠ‬ᬺ⚻ℂ 66 1 .
⨹੗⠹ 2006d ‫ࠬ࡝ࠡࠗޟ‬ක≮⇇ߦ߅ߌࠆෳᾖේଔ೙ᐲਅߩේଔ⸘▚೙ᐲߩዷ㐿 ਅ 㧦ෳᾖේଔ೙ᐲߩ⹏ଔߣ
ᣂߚߥේଔ⸘▚೙ᐲߩᮨ⚝‫⚻ޠ‬༡⎇ⓥ 57 2 .
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