按人头定价：根据既往医疗服务利用率和医生的自由裁量权进行调整。
Capitation pricing: adjusting for prior utilization and physician discretion.
作者信息
Anderson G F, Cantor J C, Steinberg E P, Holloway J
出版信息
Health Care Financ Rev. 1986 Winter;8(2):27-34.
Abstract
As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC.
摘要
随着接受风险人头付费安排下护理的医疗保险受益人数增加，设定支付费率的方法将受到越来越多的审查。有人提议对当前的调整后人均成本（AAPCC）方法进行一些修改，包括对既往利用率进行调整。在本文中，我们提议使用一种仅包括在住院决策中医生自由裁量权较低或适中的住院情况的利用率调整方法。这种修改避免了对防止某些可自由决定入院情况的人头付费系统的歧视。该模型也比当前的AAPCC解释了更多人均支出的差异。
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引用本文的文献
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本文引用的文献
1
Medicare capitation payments to HMOs in light of regression toward the mean in health care costs.鉴于医疗保健成本的均值回归，医疗保险向健康维护组织（HMO）支付的人头费。
Adv Health Econ Health Serv Res. 1985;6:75-100.
2
Enrollment in and disenrollment from health maintenance organizations by Medicaid recipients.医疗补助领取者加入及退出健康维护组织的情况。
Health Care Financ Rev. 1985 Spring;6(3):39-50.
3
Using prior utilization to determine payments for Medicare enrollees in health maintenance organizations.利用既往医疗服务利用率来确定健康维护组织中医疗保险参保人的支付金额。
Health Care Financ Rev. 1985 Spring;6(3):27-38.
4
Demonstrations of alternative delivery systems under Medicare and Medicaid.医疗保险和医疗补助下替代交付系统的示范。
Health Care Financ Rev. 1982 Mar;3(3):1-11.
5
Examination of the AAPCC methodology in an HMO prospective payment demonstration project.在一个健康维护组织前瞻性支付示范项目中对AAPCC方法的检验。
Group Health J. 1984 Spring;5(1):13-21.
6
Health maintenance organizations and the rationing of medical care.健康维护组织与医疗保健的配给
Milbank Mem Fund Q Health Soc. 1982 Spring;60(2):268-306.
7
Chronic disease in the workplace and the environment. Record linkage: methodologic and legal issues.工作场所和环境中的慢性病。记录链接：方法学和法律问题。
Arch Environ Health. 1984 May-Jun;39(3):169-72. doi: 10.1080/00039896.1984.9939519.
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Dealing with medical practice variations: a proposal for action.应对医疗实践差异：行动建议
Health Aff (Millwood). 1984 Summer;3(2):6-32. doi: 10.1377/hlthaff.3.2.6.
9
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Med Care. 1984 Feb;22(2):143-9. doi: 10.1097/00005650-198402000-00005.
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Adverse selection under a voucher system: grouping Medicare recipients by level of expenditure.凭证系统下的逆向选择：按支出水平对医疗保险受益人进行分组。
Inquiry. 1984 Summer;21(2):135-43.
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