Jackson T
Centre for Health Program Evaluation, Monash University, Victoria, Australia.
Aust Health Rev. 1996;19(1):27-39. doi: 10.1071/ah960027.
This paper proposes an episode of care payment system for patients with chronic illnesses, extending earlier published work on this model of ambulatory care (Duckett and Jackson 1993). The payment system relies on annual voluntary enrollment and some marginal broadening of Medicare coverage in exchange for patients' willingness to participate in an ambulatory managed care arrangement. In the context of Australian health ministers' enthusiasm for managed care, the proposal embodies an intermediate policy approach which supports greater health care efficiency while minimising the prospect for reductions in patient autonomy or serious distortions in patterns of care. The policy is not designed to be applied population-wide, but to address the issues involved with a resource-intensive patient group, those requiring ongoing management of chronic conditions.
本文提出了一种针对慢性病患者的按诊疗 episode 付费系统，扩展了此前关于这种门诊护理模式的已发表研究（达克特和杰克逊，1993 年）。该付费系统依赖于年度自愿参保以及对医疗保险覆盖范围的适度扩大，以换取患者参与门诊管理式护理安排的意愿。在澳大利亚卫生部长们对管理式护理充满热情的背景下，该提议体现了一种中间政策方法，即在支持提高医疗保健效率的同时，尽量减少患者自主权降低或护理模式严重扭曲的可能性。该政策并非旨在在全人群中实施，而是为了解决与资源密集型患者群体相关的问题，即那些需要对慢性病进行持续管理的患者。
