健康维护组织（HMO）中老年人的医疗保健利用情况：风险与成本合同的比较

Health care utilization by the elderly in HMOs: comparing risk and cost contracts.

作者信息

Siddharthan K, Reid W M

机构信息

Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, USA.

出版信息

Int J Health Care Qual Assur Inc Leadersh Health Serv. 1998;11(2-3):45-9. doi: 10.1108/09526869810206035.

DOI:10.1108/09526869810206035

PMID:10185315

Abstract

Data are utilized collected from the American Association of Health Plans, a trade association representing HMOs, to study differences in utilization patterns between medicare beneficiaries enrolled in Medicare risk and cost contracts with health plans. Utilization is measured by the number of ambulatory procedures performed, outpatient and emergency room visits, and acute and nonacute discharges. Compared to elders enrolled in risk plans, those in cost arrangements appear to exhibit higher inpatient and outpatient use. Members of for-profit plans experienced greater outpatient visits, accreditation did not appear to influence utilization, and IPA arrangements resulted in a decrease in outpatient utilization. Financial and policy issues are discussed.

摘要

数据来自美国健康计划协会，该协会是一个代表健康维护组织的行业协会，用于研究参加医疗保险风险和成本合同的医疗保险受益人与健康计划之间使用模式的差异。使用情况通过门诊手术数量、门诊和急诊室就诊次数以及急性和非急性出院次数来衡量。与参加风险计划的老年人相比，参加成本安排的老年人似乎有更高的住院和门诊使用率。营利性计划的成员门诊就诊次数更多，认证似乎不影响使用率，而独立执业协会（IPA）安排导致门诊使用率下降。文中还讨论了财务和政策问题。