Karpiel M S
Karpiel Associates, Long Beach, CA, USA.
Healthc Financ Manage. 1996 May;50(5):32-7.
As a way of gaining further control over the cost of healthcare delivery, more managed care organizations are seeking to negotiate capitated contracts for emergency department services. In many instances, these contracts do not include disincentives that would discourage primary care physicians from sending patients who require nonurgent care to emergency departments for treatment. Without such disincentives, emergency departments may have to bear a considerable financial burden for providing additional services. Prior to negotiating the terms of capitated contracts for emergency services, managers should analyze carefully how patients use emergency department resources. By negotiating with managed care organizations to include volume stop-loss provisions and other financial disincentives to curb overutilization by physicians, financial managers can help protect their organizations from the costs of overutilization.
作为进一步控制医疗服务成本的一种方式，越来越多的管理式医疗组织正在寻求就急诊科服务协商按人头付费合同。在许多情况下，这些合同并不包含会阻碍初级保健医生将需要非紧急护理的患者送往急诊科治疗的抑制措施。没有这样的抑制措施，急诊科可能不得不承担因提供额外服务而产生的相当大的财务负担。在就急诊科服务的按人头付费合同条款进行谈判之前，管理人员应仔细分析患者如何使用急诊科资源。通过与管理式医疗组织协商纳入数量止损条款和其他抑制医生过度使用的财务措施，财务经理可以帮助保护他们的组织免受过度使用成本的影响。
