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采用公私部门合作模式的医疗补助管理式医疗的成效。

Success of Medicaid managed care using a public-private sector model.

作者信息

Beyerl C L

机构信息

Wisconsin Independent Physicians Group, Inc., Milwaukee, USA.

出版信息

Manag Care Q. 1996 Winter;4(1):13-23.

Abstract

This article provides an overview of Wisconsin's Mandated Medicaid Managed Care Initiative--the physician network--Wisconsin Independent Physicians Group (WIPG) that provides and manages the medical services for many of these Medicaid recipients and the public and private sector partnership that has helped to make this program successful. Special programs, such as the Prenatal Support Program, implemented by WIPG are described along with detail regarding the successful outcomes resulting from the programs. The article also includes the quality of care, improved outcomes and financial success of the Initiative when compared to the state's Medicaid fee-for-service program counterpart. Additional discussion includes capitation versus fee-for-services payments, mandated versus voluntary enrollment, and combining social services with medical services to improve health outcomes.

摘要

本文概述了威斯康星州的强制性医疗补助管理式医疗计划——医师网络——威斯康星独立医师集团(WIPG),该集团为许多医疗补助领取者以及公共和私营部门提供并管理医疗服务,还介绍了有助于该计划取得成功的公私部门合作关系。文中描述了WIPG实施的特殊项目,如产前支持项目,并详细说明了这些项目所取得的成功成果。与该州的医疗补助按服务收费项目相比,本文还介绍了该计划的医疗质量、改善的成果以及财务成功情况。其他讨论内容包括按人头付费与按服务收费支付方式、强制参保与自愿参保,以及将社会服务与医疗服务相结合以改善健康结果。

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