Wooldridge J, Hoag S D
Health Care Financ Rev. 2000 Winter;22(2):61-83.
This article reviews Federal and State oversight of section 1115 Medicaid managed care demonstrations in Hawaii, Oklahoma, Rhode Island, and Tennessee from 1994 to 1998. Under Medicaid managed care, the Federal Government and States have had to shift their focus and resources into oversight functions that barely existed in fee-for-service (FFS) Medicaid. We find that managed care monitoring was slow to begin and not always adequate in these demonstrations. While State and Federal monitoring have improved over time, monitoring is not yet at the point of ensuring access and quality.
本文回顾了1994年至1998年期间联邦政府和州政府对夏威夷、俄克拉何马州、罗德岛州和田纳西州第1115条医疗补助管理式医疗示范项目的监督情况。在医疗补助管理式医疗模式下，联邦政府和各州不得不将重点和资源转移到监督职能上，而这些职能在按服务收费（FFS）的医疗补助模式中几乎不存在。我们发现，在这些示范项目中，管理式医疗的监测起步缓慢，而且并不总是充分的。虽然随着时间的推移，州和联邦的监测有所改善，但监测尚未达到确保医疗服务可及性和质量的程度。
