Boland P
Boland Healthcare Inc., Berkeley, CA, USA.
Healthc Financ Manage. 1997 May;51(5):54-8, 60.
All managed care stakeholders--health plan members, employers, providers, community organizations, and government entitites--share a common interest in reducing healthcare costs while improving the quality of care health plan members receive. Although capitation is a usually thought of primarily as a payment mechanism, it can be a powerful tool providers and health plans can use to accomplish these strategic objectives and others, such as restoring and maintaining the health of plan members or improving a community's health status. For capitation to work effectively as a strategic tool, its use must be tied to a corporate agenda of partnering with stakeholders to achieve broader strategic goals. Health plans and providers must develop a partnership strategy in which each stakeholder has well-defined roles and responsibilities. The capitation structure must reinforce interdependence, shift focus from meeting organizational needs to meeting customer needs, and develop risk-driven care strategies.
所有管理式医疗利益相关者——健康计划成员、雇主、医疗服务提供者、社区组织和政府实体——在降低医疗成本的同时提高健康计划成员所接受的医疗服务质量方面有着共同利益。虽然按人头付费通常主要被视为一种支付机制，但它可以成为医疗服务提供者和健康计划用来实现这些战略目标以及其他目标（如恢复和维持计划成员的健康或改善社区健康状况）的有力工具。为了使按人头付费作为一种战略工具有效发挥作用，其使用必须与与利益相关者合作以实现更广泛战略目标的企业议程挂钩。健康计划和医疗服务提供者必须制定一种伙伴关系战略，其中每个利益相关者都有明确界定的角色和责任。按人头付费结构必须加强相互依存关系，将重点从满足组织需求转移到满足客户需求，并制定风险驱动的护理战略。
