Zweifler J
University of California, San Francisco, USA.
J Health Care Poor Underserved. 1998 Nov;9(4):367-80. doi: 10.1353/hpu.2010.0263.
This article examines the financial impact on patients of family practice residents when a community health center (CHC) serving as a residency training site is converted to a capitated payment system. The costs in this analysis included using and educating family practice residents at CHCs, the cost of patient encounters at CHCs, and the cost of contracted capitated services. These costs were measured against capitated per member per month (pmpm) payments received by the CHC. If capitated patients were cared for by residents, the CHC would lose $8.42 pmpm. The CHC faced a $5.98 pmpm loss if it used staff physicians rather than residents. This analysis suggests there are educational costs associated with training physicians in capitated health care delivery systems. Family practice residencies and CHCs must prepare for the conversion to capitated systems; academic centers with managed care contracts must control patient encounter costs and utilization to remain competitive.
本文探讨了作为住院医师培训地点的社区卫生中心（CHC）转换为按人头付费系统时，对家庭医学住院医师患者产生的财务影响。该分析中的成本包括在社区卫生中心使用和培训家庭医学住院医师的成本、社区卫生中心患者诊疗的成本以及签约的按人头付费服务的成本。这些成本与社区卫生中心每月收到的按人头付费（pmpm）进行对比衡量。如果按人头付费的患者由住院医师护理，社区卫生中心每月将损失8.42美元。如果社区卫生中心使用在职医生而非住院医师，则每月面临5.98美元的损失。该分析表明，在按人头付费的医疗服务提供系统中培训医生存在教育成本。家庭医学住院医师培训项目和社区卫生中心必须为转换到按人头付费系统做好准备；签订了管理式医疗合同的学术中心必须控制患者诊疗成本和利用率，以保持竞争力。
