Retchin S M
Virginia Commonwealth University, Richmond, USA.
Clin Perform Qual Health Care. 1998 Jan-Mar;6(1):38-43.
Market influences are placing many academic health centers (AHCs) in financial distress. Competitive forces threaten the core missions of AHCs, principally because of selective contracting, which has introduced price competition to medical care. This manuscript discusses the issue of adverse selection for AHCs, the probability that patients with higher levels of illness severity seek care at, or are referred to, AHCs. AHCs are particularly vulnerable to adverse selection because of their prominence as referral centers, their specialty composition, research expertise, and the socioeconomic status of patients located proximal to their centers. The adverse selection of AHCs increases the likelihood that health plans will trim their networks to exclude them. Health plans may still contract with AHCs for tertiary care only, but this will only worsen the adverse selection at AHCs.
市场影响正使许多学术医疗中心（AHCs）陷入财务困境。竞争力量威胁着AHCs的核心使命，主要原因是选择性签约，它将价格竞争引入了医疗保健领域。本文讨论了AHCs的逆向选择问题，即病情严重程度较高的患者在AHCs就医或被转诊至AHCs的可能性。AHCs特别容易受到逆向选择的影响，因为它们作为转诊中心的突出地位、专业构成、研究专长以及其中心附近患者的社会经济地位。AHCs的逆向选择增加了健康计划缩减其网络以将它们排除在外的可能性。健康计划可能仍仅与AHCs签订三级医疗服务合同，但这只会使AHCs的逆向选择问题更加严重。
