Gemson D H, Freudenheim E, Senie R T, Elinson J, Fink R
Division of Sociomedical Sciences, Columbia University School of Public Health, New York, NY 10032.
Am J Prev Med. 1990 Nov-Dec;6(6):333-8.
Independent Practice Associations (IPAs) are the fastest growing segment of the Health Maintenance Organization (HMO) industry, but little is known about their provision of health promotion and disease prevention to subscribers. To examine the extent to which IPA policies encourage health promotion and disease prevention, we interviewed medical directors and other senior administrators of six newly developing IPA-HMOs in New York City. We also reviewed promotional literature to assess how extensively health promotion and disease prevention were marketed to the potential subscriber. Although medical protocols for preventive screening exist in most IPAs, compliance with guidelines is left largely to the individual physician's judgment for implementation. IPA respondents suggested that their physician panels are oriented toward prevention, but there is uncertain evidence in this regard, and incentive payments could discourage referrals for screening. Health education programs are sporadic. Health promotion and disease prevention do not appear to be a high priority among six newly established IPAs in New York City. We recommend several steps that would encourage IPA-HMOs to increase their health promotion activities.
独立执业协会（IPA）是健康维护组织（HMO）行业中发展最快的部分，但对于它们向参保人提供健康促进和疾病预防服务的情况却知之甚少。为了调查IPA政策在多大程度上鼓励健康促进和疾病预防，我们采访了纽约市六家新发展的IPA-HMO的医疗主任和其他高级管理人员。我们还查阅了宣传资料，以评估向潜在参保人推销健康促进和疾病预防服务的广泛程度。虽然大多数IPA都有预防性筛查的医疗方案，但指南的遵守情况在很大程度上取决于个别医生的实施判断。IPA的受访者表示，他们的医生团队以预防为导向，但这方面的证据并不确定，而且激励性支付可能会减少筛查转诊。健康教育项目是零星的。在纽约市新成立的六家IPA中，健康促进和疾病预防似乎并不是优先事项。我们建议采取几个步骤来鼓励IPA-HMO增加其健康促进活动。
