Roberto Pamela N, Mitchell Jean M, Gaskin Darrell J
US Government Accountability Office, USA.
Inquiry. 2005 Summer;42(2):145-59. doi: 10.5034/inquiryjrnl_42.2.145.
This paper analyzes how voluntary enrollment in the fee-for-service (FFS) system versus a partially capitated managed care plan affects changes in access to care over time for special needs children who receive Supplemental Security Income (SSI) due to a disability. Four indicators of access are evaluated, including specialty care, hospital care, emergency care, and access to a regular doctor. We employ the Heckman two-step estimation procedure to correct for the potential nonrandom selection bias linked to plan choice. The findings show that relative to their counterparts in the partially capitated managed care plan, SSI children enrolled in the FFS plan are significantly more likely to encounter an access problem during either of the time periods studied. Similarly, FFS enrollees are significantly more likely than partially capitated managed care participants to experience persistent access problems across three of the four dimensions of care. Possible explanations for the deterioration in access associated with FFS include the lack of case management services, lower reimbursement relative to the partially capitated managed care plan, and provider availability.
本文分析了按服务收费（FFS）系统与部分按人头付费的管理式医疗计划的自愿参保情况，对因残疾领取补充保障收入（SSI）的特殊需求儿童随时间推移获得医疗服务的变化有何影响。评估了四个医疗服务可及性指标，包括专科护理、医院护理、急诊护理以及获得普通医生服务的可及性。我们采用赫克曼两步估计程序，以纠正与计划选择相关的潜在非随机选择偏差。研究结果表明，相对于部分按人头付费的管理式医疗计划中的儿童，参加FFS计划的SSI儿童在两个研究时间段中的任何一个时间段内遇到医疗服务可及性问题的可能性显著更高。同样，FFS参保者在四个医疗服务维度中的三个维度上经历持续性医疗服务可及性问题的可能性也显著高于部分按人头付费的管理式医疗计划参与者。与FFS相关的医疗服务可及性恶化的可能解释包括缺乏病例管理服务、相对于部分按人头付费的管理式医疗计划报销较低以及医疗服务提供者的可及性。
