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优选提供者组织:新型医疗保健合作伙伴关系。

Preferred provider organizations: the new health care partnerships.

作者信息

Merz M

出版信息

Hosp Health Serv Adm. 1986 Nov-Dec;31(6):32-42.

Abstract

It is a rare hospital organization that is not involved with an HMO, PPO, or other alternative delivery system. It is a strategic imperative for most hospital organizations to participate in ventures which can direct blocs of patients. Preferred provider organizations have all the elements necessary to ensure the success of new financing and delivery arrangements--but why have so many failed to reach their promised expectations. This article describes the objectives of each of the four major participants in a PPO arrangement: providers, employers, employees, insurance carriers/administrators. Each of these partners must benefit from the new delivery/financing mechanism. Arrangements will differ given the local stage of HMO development, hospital and physician cultures, insurance company traditions, and the general "competitiveness" of the marketplace. A successful PPO arrangement will effectively address the objectives of each partner; it will provide a mechanism for bringing providers and purchasers together in developing exciting new health care financing programs.

摘要

很少有医院机构不涉及健康维护组织(HMO)、优先提供者组织(PPO)或其他替代医疗服务提供系统。对于大多数医院机构来说,参与能够引导患者群体的项目是一项战略要务。优先提供者组织具备确保新的融资和医疗服务提供安排取得成功所需的所有要素——但为何如此多的优先提供者组织未能达到预期呢?本文描述了优先提供者组织安排中四大主要参与者(提供者、雇主、员工、保险公司/管理者)各自的目标。这些合作伙伴中的每一方都必须从新的医疗服务提供/融资机制中受益。鉴于健康维护组织发展的当地阶段、医院和医生文化、保险公司传统以及市场的总体“竞争力”,各项安排会有所不同。一项成功的优先提供者组织安排将有效地实现每个合作伙伴的目标;它将提供一种机制,使提供者和购买者能够共同开发令人兴奋的新型医疗保健融资项目。

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Opportunities in PPO and HMO contracting.
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