Adams E Kathleen, Bronstein Janet M, Florence Curtis S
Rollins School of Public Health, Emory University, USA.
Inquiry. 2003 Fall;40(3):269-82. doi: 10.5034/inquiryjrnl_40.3.269.
The success of the "primary care case management (PCCM)" form of managed care implemented in many state Medicaid programs over the past several years depends in part on the expanded availability of primary care physician sites to substitute for hospital-based outpatient care and to provide a medical home for enrollees. However, the PCCM requirement for physicians to accept assignment of a caseload of patients and to provide all of their primary care likely conflicts with the approach of limited Medicaid participation favored by many Medicaid physician participants. This study examines the early impact of PCCM implementation, in the absence of physician reimbursement level increases, on the patterns of Medicaid participation by physicians in communities in Georgia and Alabama. We find that the implementation of PCCM under these conditions often was associated with reductions in the proportion of physicians participating in Medicaid, reductions in the number of very small Medicaid practices, and declines in Medicaid visit volumes across all participating physicians. We also find evidence of an overall reduction in the number of primary care visits per Medicaid enrollee, but an increase in the proportion of these visits that were for preventive care services associated with initial PCCM implementation.
在过去几年中，许多州医疗补助计划所实施的“初级保健病例管理（PCCM）”形式的管理式医疗取得成功，部分取决于初级保健医生站点的可及性有所扩大，以替代医院门诊护理，并为参保人提供医疗之家。然而，PCCM要求医生接受一定数量患者的指派并提供其所有初级保健服务，这可能与许多参与医疗补助计划的医生所青睐的有限医疗补助参与方式相冲突。本研究考察了在医生报销水平未提高的情况下，PCCM实施对佐治亚州和阿拉巴马州社区医生参与医疗补助计划模式的早期影响。我们发现，在这些情况下实施PCCM，往往伴随着参与医疗补助计划的医生比例下降、规模极小的医疗补助业务数量减少，以及所有参与医生的医疗补助就诊量下降。我们还发现有证据表明，每位医疗补助参保人的初级保健就诊次数总体减少，但与PCCM最初实施相关的预防性保健服务就诊比例有所增加。
