Forgionne G A
Information Systems Department, University of Maryland, Catonsville 21228.
Health Mark Q. 1991;8(3-4):107-18. doi: 10.1300/J026v08n03_06.
The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches.
本文报告了一种决策支持系统（DSS），该系统使健康计划管理者能够快速轻松地：（1）管理相关医疗市场（消费者偏好和竞争对手的项目）信息，以及（2）将这些信息转化为适当的医疗服务提供和/或支付政策。正如本文所展示的，该决策支持系统使供应商能够设计出具有成本效益且符合市场需求的医疗项目。该决策支持系统提供有关订阅者偏好、客户需求以及竞争对手项目的知识。然后，它帮助管理者以一种在考虑竞争的情况下最能满足消费者需求的方式构建医疗计划。这种符合市场需求的计划有可能为该项目带来大量额外收入。由于该系统的数据库主要由供应商的记录、日常交易和其他现成的文件组成，因此可以以名义上的增量成本实施该决策支持系统。本文还评估了该信息系统对现有牙科和心理健康计划总体财务绩效的影响。此外，本文研究了该系统如何在比当前方法为更多潜在受益人群提供更好服务的同时，帮助控制医疗服务成本。
