Kaufman A, Derksen D, McKernan S, Galbraith P, Sava S, Wills J, Fingado E
Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque 87131, USA.
Acad Med. 2000 Apr;75(4):323-30. doi: 10.1097/00001888-200004000-00007.
In 1997, the University of New Mexico Health Sciences Center ("the Center") created a managed care plan ("the Plan") for its uninsured patients who were county residents. The Plan's features include pooling the resources of existing county safety-net providers, enrolling patients with primary care providers at easily accessible neighborhood-based clinics, and investing in social support services, case management, and 24-hour telephone triage. After two years of the Plan's operation, the utilization of ambulatory care services by Plan enrollees, the number of discharges per 1,000 enrollees from the Center-affiliated University Hospital, and the number of hospital days per 1,000 enrollees had all dropped significantly (p < .001 for all). For the 13,114 enrollees in the Plan, University Hospital saved an estimated $1,904,872 per year in costs. The replacement of unpaid hospital days with paying patients is estimated to have yielded over $695,000 in additional revenues per year. The authors conclude that managing the care of uninsured patients in an academic health center can reduce ambulatory care and inpatient utilization and reduce the cost of care. To achieve these favorable outcomes requires the organization of services to meet the unique needs of the uninsured and underserved population.
1997年，新墨西哥大学健康科学中心（“该中心”）为其所在县的未参保患者制定了一项管理式医疗计划（“该计划”）。该计划的特点包括整合现有县安全网提供者的资源，让患者在方便前往的社区诊所登记初级保健提供者，并投资于社会支持服务、病例管理和24小时电话分诊。该计划实施两年后，计划参保者的门诊服务利用率、每1000名参保者从该中心附属大学医院出院的次数以及每1000名参保者的住院天数均显著下降（所有p值均<0.001）。对于该计划中的13114名参保者，大学医院每年节省了约1904872美元的成本。用付费患者取代未付费住院天数估计每年产生了超过695000美元的额外收入。作者得出结论，在学术健康中心管理未参保患者的护理可以降低门诊护理和住院利用率，并降低护理成本。要实现这些良好结果，需要组织服务以满足未参保和服务不足人群的独特需求。
