Rosenthal M B
Department of Health Policy and Management, Harvard School of Public Health, USA.
Health Aff (Millwood). 1999 Sep-Oct;18(5):204-13. doi: 10.1377/hlthaff.18.5.204.
While policymakers have expressed concern over the impact of risk sharing with providers on treatment patterns, the literature lacks decisive evidence on which to base policy. This paper evaluates the impact of a contracting change within a managed behavioral health organization from a fee-for-service system to a case-rate system with utilization management delegated to providers. The contracting change resulted in a 25 percent reduction in mental health visits per episode. This effect varies with the dollar amount of the case rate and is more pronounced for providers with a larger share of revenue from risk contracts and with intensive utilization management programs.
虽然政策制定者对与医疗服务提供者分担风险对治疗模式的影响表示担忧，但文献中缺乏可供政策依据的确凿证据。本文评估了一家管理式行为健康组织内从按服务收费系统转变为将利用管理委托给医疗服务提供者的按病例计费系统的影响。合同变更导致每次发作的心理健康就诊次数减少了25%。这种影响因病例费率的金额而异，对于来自风险合同收入占比更大且拥有强化利用管理计划的医疗服务提供者来说更为明显。
