Fleming N S, Fleming D G
GHAA J. 1988 Fall;9(1):4-13.
The first author, as a consultant to the Office of Prepaid Health Care, reviewed the financial status of nine IPAs for federal qualification in 1987. He found little to suggest any methodology being used for constructing primary care physician (PCP) capitation reimbursement systems. This article draws upon statistical theory and presents hypothetical examples to structure better financial arrangements based on five criteria: stop-loss reinsurance deductible levels, capitation of services related to physician practice, minimum panel size (number of patients) for capitation, stratified capitation, and inclusion of all PCPs in the capitation arrangement.
第一作者作为预付医疗保健办公室的顾问，于1987年审查了9个独立执业协会（IPA）的联邦资质财务状况。他发现几乎没有迹象表明存在用于构建初级保健医生（PCP）按人头付费报销系统的任何方法。本文借鉴统计理论并给出假设示例，以根据五个标准构建更好的财务安排：止损再保险免赔额水平、与医生执业相关服务的按人头付费、按人头付费的最小小组规模（患者数量）、分层按人头付费以及在按人头付费安排中纳入所有初级保健医生。
