Soroka M
State University of New York, State College of Optometry, NY 10010.
J Am Optom Assoc. 1990 Jul;61(7):523-6.
Physician reimbursement under Medicare has been rising by about 15 percent each year. Part of this increase is due to an increase in unnecessary tests and procedures. To control provider billing, Congress passed legislation that will establish a Medicare fees schedule and expenditure targets. Increased surveillance and monitoring of Medicare claims are taking place. Diagnostic procedures are being questioned and denied when deemed inappropriate in relation to a diagnosis. Managed care techniques also are being implemented by private insurance carriers to prevent overutilization. Clinic practice guidelines are being developed by the health professions. Optometry, as well as all other health professions, will be subject to increased utilization and quality review.
医疗保险制度下医生的报销费用每年以约15%的速度增长。这种增长的部分原因是不必要的检查和程序有所增加。为了控制医疗服务提供者的计费，国会通过了一项立法，将制定医疗保险费用表和支出目标。对医疗保险索赔的监督和监测正在加强。当诊断程序被认为与诊断不相关时，就会受到质疑并被拒绝。私人保险公司也在采用管理式医疗技术来防止过度使用。卫生专业人员正在制定临床实践指南。验光以及所有其他卫生专业都将受到更多的使用情况和质量审查。
