Schlenker R E, Shaughnessy P W
University of Colorado Health Sciences Center.
Home Health Care Serv Q. 1992;13(1-2):91-115.
This paper presents a conceptual analysis of access, quality, and cost containment incentives created by several current and potential Medicare reimbursement methodologies. The alternatives examined are methods used by health maintenance organizations (HMOs) and three options receiving national policy consideration: prospective per-visit and per-episode payment, and "bundling." The analysis found better incentives (from a policy perspective) for HMOs with integral home health units than for HMOs using outside contractors. Of the other options, per-episode payment appeared most promising, but requires accurate case mix adjustments. All approaches also require quality assurance tailored to reimbursement incentives. Topics for further research and demonstrations are suggested.
本文对当前和潜在的几种医疗保险报销方法所产生的可及性、质量和成本控制激励措施进行了概念分析。所考察的替代方案包括健康维护组织（HMO）所采用的方法以及正在接受国家政策考量的三种方案：按次前瞻性支付和按诊疗过程支付，以及“捆绑支付”。分析发现，对于拥有整合式家庭健康服务部门的健康维护组织而言，（从政策角度看）其激励措施优于使用外部承包商的健康维护组织。在其他方案中，按诊疗过程支付似乎最具前景，但需要进行准确的病例组合调整。所有方法还需要根据报销激励措施量身定制质量保证措施。文中还提出了有待进一步研究和论证的主题。
