O'Hare P K
McDermott, Will & Emery, Washington, DC, USA.
Healthc Financ Manage. 1997 Jul;51(7):35-6.
Legislation has been proposed in Congress to allow provider-sponsored organizations (PSOs) to negotiate risk contracts directly with the Medicare program and, possibly, with Medicaid programs. Initially, qualifying PSOs would not be required to be licensed as HMOS, but would be required to demonstrate fiscal solvency and meet quality assurance standards. The proposed solvency requirements, as well as requirements regarding the proportion of commercial to Medicare enrollees in a plan, would not be as rigorous for PSOs as they are for HMOs. The legislation's proponents argue that relaxing requirements for PSO risk contracting will allow Medicare and Medicaid beneficiaries more healthcare choices and better benefit packages. Opponents assert that PSOs would be given an unfair advantage in the marketplace and that consumers may be exposed to a greater risk of plan insolvency. While details of the legislation need to be reconciled, many observers predict that it will become law.
国会已提议立法，允许医疗服务提供者发起的组织（PSO）直接与医疗保险计划谈判风险合同，并有可能与医疗补助计划谈判。最初，符合条件的PSO无需获得健康维护组织（HMO）的执照，但需要证明财务偿付能力并符合质量保证标准。对于PSO而言，拟议的偿付能力要求以及计划中商业参保人与医疗保险参保人的比例要求，不会像对HMO那样严格。该立法的支持者认为，放宽对PSO风险合同的要求将为医疗保险和医疗补助受益人提供更多的医疗保健选择和更好的福利套餐。反对者则声称，PSO将在市场上获得不公平优势，消费者可能面临计划破产的更大风险。虽然该立法的细节需要协调，但许多观察家预测它将成为法律。
