Welch W P
Urban Institute, Washington, DC 20037.
Health Care Financ Rev. 1992 Spring;13(3):97-110.
The payment received by a health maintenance organization (HMO) for its Medicare enrollees is proportionate to the average cost of Medicare beneficiaries in that county. However, HMO market share in an area appears to decrease costs in the fee-for-service sector, so that HMOs are paid less. For this and other reasons, alternative payment formulas may be desirable and several are developed in this article. The conceptually simplest location factor would be an input price index. An alternative strategy would also recognize systematic variation in utilization. Utilization rate is regressed on variables such as county population density and physicians per 1,000 persons. The predicted utilization rate times an input price index could serve as a location factor. The value of alternative location factors are presented for specific counties.
健康维护组织（HMO）从其医疗保险参保人那里获得的支付，与该县医疗保险受益人的平均成本成比例。然而，HMO在某一地区的市场份额似乎会降低按服务收费部门的成本，因此HMO获得的支付较少。出于这个以及其他原因，替代支付公式可能是可取的，本文中开发了几种替代支付公式。概念上最简单的区位因素将是一个投入价格指数。另一种策略也会考虑到利用方面的系统差异。利用率会根据县人口密度和每千人医生数量等变量进行回归分析。预测的利用率乘以一个投入价格指数可以作为一个区位因素。文中给出了特定县的替代区位因素的值。
