Miller R H, Luft H S
Institute for Health and Aging, University of California, San Francisco.
Front Health Serv Manage. 1993 Spring;9(3):3-37; discussion 53-4.
Enrollment in network-based managed care plans has grown rapidly, raising important questions about the actual impact of different types of managed care plans on health care use, expenditure, and quality of care. In this article, we analyze the literature on the performance of managed care plans relative to fee-for-service plans. We find strong evidence that staff- and group-model HMOs have lowered utilization and expenditure relative to fee-for-service while maintaining quality of care. The relatively sparse evidence is more mixed on the performance of newer forms of managed care organizations (MCOs). We also speculate on future trends in network-based managed care. It is likely that employers will increase their economic leverage with managed care firms, accelerating processes that are leading to greater concentration of marketshare among managed care firms. In turn, newer forms of MCOs will increase their economic leverage with providers, which will help MCOs contain costs and monitor quality. Some of the newer MCOs will adapt important features of staff- and group-model HMOs, including increased emphasis on provider selection and reselection.
加入基于网络的管理式医疗计划的人数增长迅速，这引发了一些重要问题，即不同类型的管理式医疗计划对医疗服务使用、支出和医疗质量的实际影响。在本文中，我们分析了关于管理式医疗计划相对于按服务收费计划表现的文献。我们发现有力证据表明，与按服务收费相比，员工型和团体模式的健康维护组织（HMO）降低了利用率和支出，同时保持了医疗质量。关于新型管理式医疗组织（MCO）的表现，相对较少的证据则较为复杂。我们还推测了基于网络的管理式医疗的未来趋势。雇主可能会增强他们对管理式医疗公司的经济影响力，加速导致管理式医疗公司市场份额更加集中的进程。反过来，新型MCO将增强他们对医疗服务提供者的经济影响力，这将有助于MCO控制成本并监督质量。一些新型MCO将采用员工型和团体模式HMO的重要特征，包括更加强调对医疗服务提供者的选择和重新选择。
