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牙科保险中的按人头付费和定额给付。

Capitation and indemnity in dental insurance.

作者信息

Tekavec M M, Tekavec C D

出版信息

Curr Opin Dent. 1991 Oct;1(5):659-63.

PMID:1807465
Abstract

The literature reviewed over the past year indicates several new trends in the area of health care capitation and indemnity third-party coverage. These trends point toward an increase in capitation and managed care and a decrease in traditional indemnity insurance. As employers seek to control all types of health care costs, they will also require employees to take care of a larger portion of the bill. As managed care plans increase, there will be a new emphasis on methods of plan evaluation. Cost will cease to be the only consideration. As quality comes into greater focus, there will be a need to define quality care in objective terms. Parameters of care will be needed as well as performance standards. Providers will be put increasingly at financial risk as managed care administrators seek to reduce provider numbers and control utilization. Capitated dental care is not as prevalent nationwide as is capitated medical care. Developments in general health care will influence how widespread it will become in the next decade.

摘要

过去一年所查阅的文献表明,在医疗保健按人头付费和第三方赔偿保险领域出现了几个新趋势。这些趋势表明按人头付费和管理式医疗有所增加,而传统的赔偿保险则有所减少。随着雇主试图控制各类医疗保健成本,他们也将要求员工承担更大比例的费用。随着管理式医疗计划的增加,将重新强调计划评估方法。成本将不再是唯一的考量因素。随着质量受到更多关注,需要用客观的术语来定义优质护理。需要护理参数以及绩效标准。随着管理式医疗管理人员试图减少医疗服务提供者数量并控制医疗服务利用率,医疗服务提供者将面临越来越大的财务风险。按人头付费的牙科护理在全国范围内不如按人头付费的医疗护理普遍。一般医疗保健的发展将影响其在未来十年的普及程度。

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