Campion D M, Dickey D F
Alpha Center, Washington, DC 20036, USA.
J Rural Health. 1995 Winter;11(1):32-9. doi: 10.1111/j.1748-0361.1995.tb00394.x.
The Essential Access Community Hospital (EACH) Program is testing a concept for limited-service hospitals established under Medicare called the Rural Primary Care Hospital (RPCH). The program uses cost-based reimbursement and relaxed regulatory requirements to help low-volume rural hospitals shift emphasis from acute care to primary care and emergency services. RPCHs must form "horizontal" networks with larger hospitals and may form "vertical" arrangements with ambulatory service providers and practitioners. A small number of rural hospitals have converted to the RPCH status since the program entered the implementation stage in late 1993. It is unclear how many other hospitals will convert given uncertainty regarding the financial impact of RPCH conversion and concerns with certain requirements. The program illustrates how payment policies can provide incentives for network development and reflects the importance of physician involvement and technical assistance in developing limited-service hospitals. In addition, it appears that EACH/RPCH networks that form under the program may serve as building blocks for broader networks, as the seven states involved in the program look to develop rural health networks that go beyond the EACH/RPCH model.
基本医疗可及性社区医院（EACH）项目正在测试一种针对根据医疗保险设立的有限服务医院的概念，即农村初级保健医院（RPCH）。该项目采用基于成本的报销方式和宽松的监管要求，以帮助低诊疗量的农村医院将重点从急性护理转向初级保健和急诊服务。农村初级保健医院必须与大型医院建立“横向”网络，并且可以与门诊服务提供商和从业者建立“纵向”安排。自该项目于1993年末进入实施阶段以来，已有少数农村医院转变为农村初级保健医院的状态。鉴于农村初级保健医院转变带来的财务影响存在不确定性以及对某些要求的担忧，尚不清楚还有多少其他医院会进行转变。该项目说明了支付政策如何能够为网络发展提供激励，并反映出医生参与和技术援助在发展有限服务医院方面的重要性。此外，由于参与该项目的七个州希望发展超越EACH/RPCH模式的农村健康网络，该项目下形成的EACH/RPCH网络似乎可能成为更广泛网络的基石。
