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通过人头付费整合支付方和医疗服务提供方的风险。

Integrating payer and provider risk through capitation.

作者信息

Barth S M

机构信息

Independence Blue Cross Family of Companies, Philadelphia, PA, USA.

出版信息

Manag Care Q. 1997 Winter;5(1):19-24.

Abstract

Capitation payment mechanisms promote conservative use of medical resources by transferring risk to the decision maker, the physician. However, there is another view of capitation: defining common risk between provider-driven organizations (i.e., physician/hospital organizations (PHOs) or integrated delivery systems (IDS), and risk-managing entities such as HMOs or insurance companies. This article discusses a strategy to align provider and risk manager incentives to share the risks and rewards for a total book of business or population.

摘要

按人头付费机制通过将风险转移给决策者(即医生)来促进医疗资源的保守使用。然而,对于按人头付费还有另一种观点:界定由提供者驱动的组织(即医师/医院组织(PHOs)或综合服务体系(IDS))与诸如健康维护组织(HMOs)或保险公司等风险管理实体之间的共同风险。本文讨论了一种策略,以使提供者和风险管理者的激励措施保持一致,从而就全部业务量或全体人群来分担风险与回报。

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