Custer W S
Employee Benefit Research Institute, Washington, DC 20037-2121.
Inquiry. 1991 Spring;28(1):81-6.
This study uses claims data from employers in the Houston Area Health Care Coalition (HAHCC) for 1985 through the first half of 1987 to examine the effect of health care plan attributes on health care costs. Plan attributes affect the site of care and the costs of care. Utilization review clearly was effective in reducing the demand for inpatient services, but that reduction was in large measure matched by increases in care in the outpatient setting. Restrictions on mental health benefits also shifted the site of care. In contrast, neither premium sharing nor the plan's deductible had a significant impact on total plan charges. The study results demonstrate the need to have a comprehensive cost management strategy.
本研究使用了休斯顿地区医疗保健联盟（HAHCC）中雇主在1985年至1987年上半年的理赔数据，以检验医疗保健计划属性对医疗保健成本的影响。计划属性会影响医疗地点和医疗成本。利用审查在减少住院服务需求方面显然是有效的，但这种减少在很大程度上被门诊环境中医疗服务的增加所抵消。对心理健康福利的限制也改变了医疗地点。相比之下，保费分担和计划免赔额对计划总费用均无显著影响。研究结果表明需要制定全面的成本管理策略。
