Oppenheimer Caitlin Carroll, Shapiro Jennifer R, Beronja Nancy, Dykstra Dawn M, Gaylin Daniel S, Held Philip J, Rubin Robert J
National Opinion Research Center, Washington, DC 20036, USA.
Health Care Financ Rev. 2003 Summer;24(4):7-29.
Individuals with end stage renal disease (ESRD), most of whom are insured by Medicare, are generally prohibited from enrolling in Medicare managed care plans (MCPs). CMS offered ESRD patients the opportunity to participate in an ESRD managed care demonstration mandated by Congress. The demonstration tested whether managed care systems would be of interest to ESRD patients and whether these approaches would be operationally feasible and efficient for treating ESRD patients. This article examines the structure, implementation, and operational outcomes of the three demonstration sites, focusing on: the structure of these managed care programs for ESRD patients, requirements needed to attract and enroll patients, and the challenges of introducing managed care programs in the ESRD arena.
患有终末期肾病（ESRD）的个体，其中大多数由医疗保险承保，通常被禁止加入医疗保险管理式医疗计划（MCPs）。医疗保险和医疗补助服务中心（CMS）为ESRD患者提供了参与国会授权的ESRD管理式医疗示范项目的机会。该示范项目测试了管理式医疗系统是否会受到ESRD患者的青睐，以及这些方法在治疗ESRD患者方面在操作上是否可行和有效。本文考察了三个示范地点的结构、实施情况和运营成果，重点关注：这些针对ESRD患者的管理式医疗项目的结构、吸引和招募患者所需的要求，以及在ESRD领域引入管理式医疗项目所面临的挑战。
