Serrato C, Brown R S, Bergeron J
Mathematica Policy Research, Inc., Princeton, NJ 08543, USA.
Health Care Financ Rev. 1995 Fall;17(1):85-97.
Only 17 of the 38 health maintenance organizations (HMOs) that have Medicare risk contracts and offer coverage to commercial clients in rural counties include the rural counties in their Medicare plan service areas. Rural counties in which HMOs offer Medicare coverage have higher average adjusted average per capita costs (AAPCCs), larger populations, and more physicians per capita than rural counties excluded by risk plans. Interviewed plans cite low and erratic AAPCCs, scarcity of potential enrollees, lack of negotiating power with physicians, and adverse selection as drawbacks in rural areas. Proposed changes to the payment methodology would probably lead HMOs to increase their Medicare offerings in urban fringe areas, but not in isolated rural areas.
在38个拥有医疗保险风险合同并为农村县的商业客户提供保险的健康维护组织（HMO）中，只有17个将农村县纳入其医疗保险计划服务区域。与被风险计划排除的农村县相比，HMO提供医疗保险的农村县的平均调整后人均成本（AAPCC）更高、人口更多且人均医生数量更多。接受采访的计划指出，AAPCC低且不稳定、潜在参保人稀缺、与医生缺乏谈判能力以及逆向选择是农村地区的缺点。支付方式的拟议变更可能会导致HMO增加其在城市边缘地区的医疗保险服务，但不会在偏远农村地区增加。
