Bindman A B, Grumbach K, Bernheim S, Vranizan K, Cousineau M
University of California, San Francisco, USA.
Health Aff (Millwood). 2000 Jan-Feb;19(1):194-202. doi: 10.1377/hlthaff.19.1.194.
A growing percentage of Medicaid patients are receiving medical care within a managed care system. This policy change has raised concerns about whether safety-net providers can maintain their share of Medi-Cal (California Medicaid) patients. From 1995 to 1997 several of California's counties implemented mandatory Medi-Cal managed care. The majority of California's safety-net primary care clinics experienced a decline in the percentage of their patients insured by Medi-Cal. However, after the overall decline in the number of Medi-Cal beneficiaries was controlled for, the increased penetration of Medi-Cal managed care in a county was not independently associated with a decline in clinics' share of Medi-Cal patients. Despite this fact, it may become increasingly difficult for clinics to maintain their current level of services with declining Medi-Cal enrollment and other anticipated reforms in their funding.
越来越多的医疗补助患者在管理式医疗系统内接受医疗服务。这一政策变化引发了人们对安全网提供者能否维持其在加州医疗补助（加利福尼亚州医疗补助计划）患者中所占份额的担忧。1995年至1997年期间，加利福尼亚州的几个县实施了强制性的医疗补助管理式医疗。加利福尼亚州大多数安全网初级保健诊所中，由医疗补助计划承保的患者比例有所下降。然而，在对医疗补助受益人的总体数量下降进行控制后，一个县内医疗补助管理式医疗渗透率的提高与诊所医疗补助患者份额的下降并无独立关联。尽管如此，随着医疗补助登记人数的下降以及资金方面其他预期的改革，诊所要维持其当前的服务水平可能会变得越来越困难。
