Schneikart M
COHR, Los Angeles, CA.
Physician Exec. 1994 Sep;20(9):31-2.
Through the use of managed care techniques in recent years, the insurance industry has tried to bring the runaway costs of medical care under control. The result of this control effort is system access limitations, compared to the full choice indemnity plans of the past. This limited system access has now clearly moved HMOs and other managed care organizations into the category of "potentially liable health care entities," based on patient steerage, economic disincentives, and limited choices of the plan's participating providers and facilities. Just as hospitals have had to exercise rigorous care in the credentialing of members of their medical staffs, managed care organizations will have to ensure that the providers they use meet acceptable standards of competence.
近年来，通过运用管理式医疗技术，保险业试图控制医疗费用的飙升。与过去全面选择的赔偿计划相比，这种控制措施的结果是系统准入受限。基于患者引导、经济抑制因素以及该计划参与提供者和设施选择有限，这种有限的系统准入如今已明确将健康维护组织（HMO）和其他管理式医疗组织归入“潜在责任医疗实体”类别。正如医院必须在其医务人员资格认证方面严格把关一样，管理式医疗组织将不得不确保其使用的提供者符合可接受的能力标准。
