Remler D K, Gray B M, Newhouse J P
Division of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Inquiry. 2000 Fall;37(3):304-16.
Using the results of a 1995 nationally representative survey of physicians, this paper examines the relationship between exposure to managed care and resources expended by physicians on administrative and insurance matters. Our measures of managed care exposure are the degree to which a physician experiences a variety of managed care techniques (i.e., utilization review, capitation payment, restricted panels, gatekeepers, discounted fees, compensation links to utilization measures, profiling, protocols, and salary payment). Physicians report expending, on average, three hours per week on insurance-related matters and 4.8 hours per week on administration. Although managed care techniques affect administrative and insurance-related burdens, the direction of that effect varies according to the form that managed care exposure takes. With the exception of being salaried, none of our variables has an economically significant effect on physicians' administrative/insurance burdens, even at the outer-most edge of the 95% confidence interval. Overall, our findings contradict the widely held notion that managed care dramatically raises the administrative and insurance burden of physicians.
本文利用1995年一项具有全国代表性的医生调查结果，研究了接触管理式医疗与医生在行政和保险事务上所耗费资源之间的关系。我们衡量接触管理式医疗的指标是医生体验各种管理式医疗技术的程度（即利用情况审查、按人头付费、受限医疗小组、把关人制度、折扣费用、薪酬与利用情况指标挂钩、质量评估、医疗方案以及薪资支付）。医生报告称，平均每周在与保险相关的事务上花费3小时，在行政事务上花费4.8小时。尽管管理式医疗技术会影响行政和与保险相关的负担，但其影响方向会因接触管理式医疗的形式不同而有所差异。除了领取薪水外，即使在95%置信区间的最边缘，我们的变量中没有一个对医生的行政/保险负担产生具有经济意义的影响。总体而言，我们的研究结果与广泛持有的观点相矛盾，即管理式医疗会大幅增加医生的行政和保险负担。
