Graber D R, Kilpatrick A O
Medical University of South Carolina, USA.
J Health Hum Serv Adm. 1997 Spring;19(4):410-24.
Health providers are rapidly establishing integrated delivery systems to prepare for managed care and capitation. However, acute and primary services for the elderly continue to be reimbursed through DRGs or fee-for-service (FFS) payments. Different incentives and care patterns are described for providers caring for elderly populations and younger, capitated groups. Pilot programs to provide Medicare services to the elderly may become models or foundations for a future, capitated health system for the elderly. Existing models of elderly health care that receive capitated payments are described in this article, including Social HMOs, TEFRA HMOs. and PACE programs. The potential significance of these programs for the synchrony of operational incentives, comprehensiveness of health care, volume of institutional services, and primary care orientation is analyzed.
医疗服务提供者正在迅速建立综合服务体系，为管理式医疗和按人头付费做准备。然而，针对老年人的急症和初级服务仍通过诊断相关分组（DRGs）或按服务收费（FFS）进行报销。针对照顾老年人群体和年轻的按人头付费群体的医疗服务提供者，描述了不同的激励措施和护理模式。为老年人提供医疗保险服务的试点项目可能会成为未来针对老年人的按人头付费医疗体系的模式或基础。本文介绍了接受按人头付费的现有老年医疗保健模式，包括社会健康维护组织（Social HMOs）、《税收公平与财政责任法案》健康维护组织（TEFRA HMOs）和PACE项目。分析了这些项目在运营激励同步性、医疗保健全面性、机构服务量和初级保健导向方面的潜在意义。
