Christianson J B, Hamer R, Knutson D, Wellever A
Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis 55455, USA.
J Rural Health. 1997 Summer;13(3):240-52. doi: 10.1111/j.1748-0361.1997.tb00848.x.
The growth of managed care in general suggests that a substantially larger number of rural primary care physicians will be asked to enter into risk-bearing contracts with Health Maintenance Organizations (HMOs) in the near future. This article describes the different types of payment and risk-sharing arrangements that exist between HMOs and primary care physicians and presents survey data relating to their prevalence in rural areas. Also, it describes in detail the payment arrangements used by four HMOs that contract with rural primary care physicians. The concluding discussion highlights policy issues regarding risk-sharing arrangements that are especially pertinent in rural settings.
总体而言，管理式医疗的发展表明，在不久的将来，将会有大量更多的农村初级保健医生被要求与健康维护组织（HMO）签订风险承担合同。本文描述了HMO与初级保健医生之间存在的不同类型的支付和风险分担安排，并呈现了有关其在农村地区普及情况的调查数据。此外，本文详细描述了与农村初级保健医生签约的四家HMO所采用的支付安排。最后的讨论突出了与风险分担安排相关的政策问题，这些问题在农村环境中尤为重要。
