Ettner Susan L, Argeriou Milton, McCarty Dennis, Dilonardo Joan, Liu Hui
UCLA Department of Medicine, Division of General Internal Medicine, Health Services Research, 911 Broxton Plaza, Room 106, Los Angeles, CA 90095, USA.
J Behav Health Serv Res. 2003 Jan-Feb;30(1):26-40. doi: 10.1007/BF02287811.
Concerns about access under managed care have been raised for vulnerable populations such as publicly funded patients with substance abuse problems. To estimate the effects of the Iowa Managed Substance Abuse Care Plan (IMSACP) on substance abuse service use by publicly funded patients, service use before and after IMSACP was compared; adjustments were made for changes in population sociodemographic and clinical characteristics. Between fiscal years 1994 and 1997, patient case mix was marked by a higher burden of illness and the use of inpatient, residential nondetox, outpatient counseling, and assessment services declined, while use of intensive outpatient and residential detox services increased. Findings were similar among women, children, and homeless persons. Thus, care moved away from high-cost inpatient settings to less costly venues. Without knowing the impact on treatment outcomes, these changes cannot be interpreted as improved provider efficiency versus simply cost containment and profit maximization.
对于诸如患有药物滥用问题的公共资助患者等弱势群体，人们对管理式医疗下的服务可及性表示担忧。为了评估爱荷华州药物滥用管理护理计划（IMSACP）对公共资助患者药物滥用服务使用情况的影响，比较了IMSACP实施前后的服务使用情况；对人口社会人口统计学和临床特征的变化进行了调整。在1994财年至1997财年期间，患者病例组合的特点是疾病负担较重，住院、非戒毒住院、门诊咨询和评估服务的使用减少，而强化门诊和戒毒住院服务的使用增加。在女性、儿童和无家可归者中也有类似的发现。因此，护理从高成本的住院环境转向了成本较低的场所。在不知道对治疗结果影响的情况下，这些变化不能被解释为提高了医疗服务提供者的效率，而仅仅是成本控制和利润最大化。
