Riley W A, Schneckenburger W A
Department of Medicine, Greater Baltimore Medical Center, MD 21204.
JAMA. 1991 Aug 28;266(8):1118-22.
Two unique models for caring for the uninsured and underinsured are operating in Maryland. The first is a group practice, primary care model with a unique ambulatory Medicare waiver that has had a positive impact on patients and physicians. The second is a financial model--an all-payer prospective rate-setting system for all critical care inpatient hospitals that, during a 13-year period from 1977 through 1989, has saved the citizens of the state approximately $5.361 billion, has allowed hospitals to provide $1.657 billion of charity care and bad debts, and has earned $517 million in net profits. The reasons for the success of each of the models are discussed and form the basis for a practical and politically feasible proposal: merge the best aspects of each model into an ambulatory primary care-based model financed through an all-payer prospective charge system.
马里兰州正在运行两种独特的模式来照顾未参保和参保不足的人群。第一种是团体医疗模式，即初级保健模式，它拥有独特的门诊医疗保险豁免权，对患者和医生都产生了积极影响。第二种是财务模式——一种针对所有重症监护住院医院的全支付方前瞻性费率设定系统，在1977年至1989年的13年期间，为该州公民节省了约53.61亿美元，使医院能够提供16.57亿美元的慈善护理和坏账，并获得了5.17亿美元的净利润。文中讨论了每种模式成功的原因，并以此为基础提出了一个切实可行且在政治上可行的提议：将每种模式的最佳方面合并为一个基于门诊初级保健的模式，并通过全支付方前瞻性收费系统提供资金支持。
