Docteur E R, Colby D C, Gold M
Physician Payment Review Commission, Washington, DC 20037, USA.
Health Care Financ Rev. 1996 Summer;17(4):5-21.
Medicare managed care enrollment growth points to the need to develop an approach for monitoring access to care for the increasing number of beneficiaries who use these arrangements. This article describes the issues to be addressed in designing a system for monitoring managed care plan enrollees' ability to obtain needed medical care on a timely basis. We review components of the monitoring approach used for traditional fee-for-service (FFS) Medicare, including the conceptual framework, data, measures, and subgroups targeted in monitoring efforts, and discuss the adaptation of that approach for monitoring access in Medicare managed care.
医疗保险管理式医疗参保人数的增长表明，需要制定一种方法来监测越来越多使用这些医保形式的受益人的就医机会。本文描述了在设计一个监测管理式医疗计划参保人及时获得所需医疗服务能力的系统时需要解决的问题。我们回顾了用于传统按服务项目付费（FFS）医疗保险的监测方法的组成部分，包括概念框架、数据、指标以及监测工作所针对的亚组，并讨论了该方法在监测医疗保险管理式医疗就医机会方面的适应性。
