Markus Anne Rossier, Rosenbaum Sara, Sonosky Colleen, Repasch Lee, Mauery D Richard
Department of Health Policy, George Washington University, School of Public Health and Health Services in Washington, DC 20006, USA.
Manag Care Interface. 2005 Jun;18(6):24-30.
State Medicaid/Children's Health Insurance Program (SCHIP) agencies play pivotal roles in ensuring that participating health plans provide quality care. In 2003, researchers interviewed SCHIP officials with oversight responsibilities in nine states and found that all agencies had formal monitoring procedures and that all of them regularly collected data that measured health plans' compliance with quantifiable standards. Several states designed a graduated incentive and penalty system, which they believed favored compliance. Many agencies also stressed the need for collaboration with participating plans, because of underlying systemic barriers. None of the surveyed states considered their contractual agreements with health plans as all-encompassing on quality improvement, which underscores the importance of additional, noncontractual strategies to improve the quality of care. The survey found a disparity between state expectations for health plan performance and the realities of the delivery system, including the priorities of health plans and providers. The sample states were good monitors who enforced general contractual standards of pediatric quality of care; however, one shortcoming was found. Few of the surveyed states focused on oral disease or lead poisoning as part of their overall quality improvement efforts.
州医疗补助/儿童健康保险计划（SCHIP）机构在确保参与的健康计划提供优质医疗服务方面发挥着关键作用。2003年，研究人员采访了九个州中负有监督职责的SCHIP官员，发现所有机构都有正式的监测程序，并且都定期收集衡量健康计划是否符合可量化标准的数据。几个州设计了分级激励和惩罚系统，他们认为这有利于促进合规。由于存在潜在的系统性障碍，许多机构还强调了与参与计划合作的必要性。没有一个被调查的州认为其与健康计划的合同协议在质量改进方面是全面的，这凸显了额外的非合同策略对提高医疗质量的重要性。调查发现，州对健康计划绩效的期望与医疗服务提供系统的实际情况之间存在差距，包括健康计划和医疗机构的优先事项。抽样州是执行儿科医疗质量一般合同标准的优秀监督者；然而，也发现了一个缺点。很少有被调查的州将口腔疾病或铅中毒作为其整体质量改进工作的一部分。
