Carey T S, Weis K, Homer C
Department of Medicine, University of North Carolina, Chapel Hill 27599-7110.
Health Serv Res. 1991 Jun;26(2):165-81.
Enrollment of Medicaid recipients into capitated, case-managed systems has been advocated as a method of controlling cost. We studied prenatal care and birth outcomes for women and children enrolled in Aid to Families with Dependent Children (AFDC) in two capitated programs in Santa Barbara, California and Jackson County, Missouri (Prepaid), compared with similar but fee-for-service comparison medical communities in Ventura County, California and St. Louis, Missouri (FFS). At the sites of care, 2,336 inpatient and 823 prenatal care records were abstracted. Women at all sites received fewer than the recommended number of prenatal visits. At no site did more than 40 percent of women receive prenatal care in the first trimester of pregnancy. Mean birth weight and proportion of children of low birth weight (less than 2,500 grams) were similar between the demonstration and comparison counties. Complications of pregnancy and cesarean section rates were also similar between demonstration and comparison counties. This study did not demonstrate a decreased quality of care provided to enrollees in capitated, case-managed Medicaid programs compared with fee-for-service. Basic prenatal care was provided only to some members of this population, regardless of the type of physician payment.
将医疗补助受助人纳入按人头付费、病例管理系统，已被倡导作为一种控制成本的方法。我们研究了加利福尼亚州圣巴巴拉市和密苏里州杰克逊县（预付费）两个按人头付费项目中，参与抚养儿童家庭援助计划（AFDC）的妇女和儿童的产前护理及分娩结局，并与加利福尼亚州文图拉县和密苏里州圣路易斯市类似但采用按服务收费的对照医疗社区（FFS）进行了比较。在各护理地点，提取了2336份住院记录和823份产前护理记录。所有地点的妇女接受的产前检查次数均少于推荐次数。在任何地点，怀孕头三个月接受产前护理的妇女比例均未超过40%。示范县和对照县之间的平均出生体重及低出生体重儿童（低于2500克）比例相似。示范县和对照县之间的妊娠并发症及剖宫产率也相似。与按服务收费相比，本研究并未表明，参与按人头付费、病例管理的医疗补助项目的受助人所接受的护理质量有所下降。无论医生付费方式如何，该人群中只有部分成员获得了基本产前护理。
