McKay N L
University of Florida, USA.
J Healthc Manag. 1998 Mar-Apr;43(2):169-81; discussion 182-4.
In order to facilitate the process of determining how best to respond to the recent growth of rural managed care, this study discusses various organizational alignments for managed care contracting. The organizational alignments are divided into three categories: remain independent, enter into a contractual arrangement, or develop an informal agreement. For each category, the article explains the option, examines advantages and disadvantages, and presents empirical evidence about the observed effects. The purpose is to present a comprehensive menu of possibilities so that rural hospitals, given their own needs and objectives, may evaluate the options. Although situations differ for individual hospitals, certain general conclusions emerge. First, contracting with managed care organizations as an independent entity is likely to be most attractive to rural hospitals that have a strong patient base. Second, rural hospitals will be more likely to enter into contractual arrangements for managed care contracting when financial pressures dominate the potential loss of autonomy and control. Finally, developing an informal agreement with other healthcare providers for purposes of managed care contracting is likely to be desirable as an intermediate step, or way of experimenting with collective action before entering into a contractual arrangement.
为了便于确定如何以最佳方式应对农村管理式医疗最近的发展，本研究讨论了管理式医疗签约的各种组织合作形式。这些组织合作形式分为三类：保持独立、签订合同安排或达成非正式协议。对于每一类，本文都解释了该选项，审视了其优缺点，并给出了关于观察到的效果的实证证据。目的是提供一份全面的可能性清单，以便农村医院根据自身需求和目标评估这些选项。尽管各医院情况不同，但仍得出了一些一般性结论。首先，对于拥有强大患者群体的农村医院来说，作为独立实体与管理式医疗组织签约可能最具吸引力。其次，当财务压力超过潜在的自主权和控制权损失时，农村医院更有可能就管理式医疗签约达成合同安排。最后，为管理式医疗签约目的与其他医疗服务提供者达成非正式协议，作为进入合同安排之前的中间步骤或试验集体行动的方式，可能是可取的。
