Inquiry. 2002 Fall;39(3):207-20. doi: 10.5034/inquiryjrnl_39.3.207.
Together with the American Association of Health Plans (AAHP), we surveyed health maintenance organizations (HMOs) in 1998 to characterize their basic structure and management strategies. The findings show that more than half of HMO enrollees belong to plans that contract with primary care physician (PCP) groups on a predominantly capitated basis. Such plans tend to be larger and to contract with large physician groups. Thirty percent to 40% of enrollees are in plans that delegate utilization and network management to physician groups paid by capitation, but plans almost never delegate these functions to groups paid by fee-for-service. Plans tend to retain quality assurance functions irrespective of whether they use fee-for-service or capitation as a basis for physician payment. The autonomy of PCPs to order tests and procedures varies with the test and procedure.
1998年，我们与美国健康计划协会（AAHP）共同对健康维护组织（HMO）进行了调查，以描述其基本结构和管理策略。调查结果显示，超过一半的HMO参保者所属的计划主要以按人头付费的方式与初级保健医生（PCP）团体签约。这类计划往往规模较大，并与大型医生团体签约。30%至40%的参保者所在的计划将利用情况和网络管理委托给按人头付费的医生团体，但这类计划几乎从不将这些职能委托给按服务收费的团体。无论计划是以按服务收费还是按人头付费作为医生薪酬的基础，它们往往都会保留质量保证职能。初级保健医生开具检查和治疗程序的自主权因检查和治疗程序而异。
