Phillips K A, Fernyak S, Potosky A L, Schauffler H H, Egorin M
Department of Clinical Pharmacy, University of California, San Francisco (UCSF), USA.
Health Aff (Millwood). 2000 Jan-Feb;19(1):102-16. doi: 10.1377/hlthaff.19.1.102.
We examined whether enrollees in managed care plans received more preventive services than enrollees in non-managed care plans did, by conducting an updated literature synthesis of studies published between 1990 and 1998. We found that 37 percent of comparisons indicated that managed care enrollees were significantly more likely to obtain preventive services; 3 percent indicated that they were significantly less likely to do so; and 60 percent found no difference. Enrollees in group/staff-model health maintenance organizations (HMOs) were more likely to receive preventive services, but there was little evidence, outside of Medicaid managed care, that managed care plans are worse at providing preventive services. However, most of the evidence is equivocal: Provision of preventive services was neither better nor worse in managed versus non-managed care plans. Because of the blurred distinctions among types of health plans, more research is needed to identify which plan characteristics are most likely to encourage appropriate utilization.
我们通过对1990年至1998年间发表的研究进行最新的文献综述，来考察参加管理式医疗计划的参保者是否比参加非管理式医疗计划的参保者获得更多的预防服务。我们发现，37%的比较结果表明，参加管理式医疗的参保者获得预防服务的可能性显著更高；3%的结果表明他们获得预防服务的可能性显著更低；60%的结果未发现差异。参加团体/员工模式健康维护组织（HMO）的参保者更有可能获得预防服务，但除了医疗补助管理式医疗外，几乎没有证据表明管理式医疗计划在提供预防服务方面更差。然而，大多数证据并不明确：在提供预防服务方面，管理式医疗计划与非管理式医疗计划并无优劣之分。由于各类健康计划之间的区别模糊不清，需要更多研究来确定哪些计划特征最有可能鼓励适当利用预防服务。
