Welch W P, Hillman A L, Pauly M V
Urban Institute, Washington, DC 20037.
Milbank Q. 1990;68(2):221-43.
The evolution of health maintenance organizations (HMOs) has entailed changes in both their structural characteristics and incentives to attract physicians' participation. Previous classifications of HMOs have failed to capture explicitly key features of these changes. Two alternative typologies based on incentives or organizational structures may be constructed by examining precise forms of two- or three-tiered contractual arrangements, physicians' payment methods, clienteles served, and means of pooling risks. Classifications of these kinds may represent or aid in generating a valid typology to help managers, consumers, providers, and analysts understand better how HMOs operate and which factors are critical in the dynamic managed-care industry.
健康维护组织（HMOs）的发展使其在结构特征和吸引医生参与的激励措施方面都发生了变化。以往对HMOs的分类未能明确捕捉到这些变化的关键特征。通过审视两层或三层合同安排的具体形式、医生的支付方式、所服务的客户群体以及风险分担方式，可以构建基于激励措施或组织结构的两种替代类型学。这类分类可能代表或有助于生成有效的类型学，以帮助管理者、消费者、提供者和分析师更好地理解HMOs的运作方式，以及在动态的管理式医疗行业中哪些因素至关重要。
