Reddy Swapna, Finley Marisa, Posey Dan, Rohack James J
Scott & White Center for Healthcare Policy, Temple, TX, USA.
South Med J. 2012 Oct;105(10):545-50. doi: 10.1097/SMJ.0b013e318266f987.
We set out to determine whether expanding Medicaid managed care in Texas is the solution to the challenges faced by the state of meeting the healthcare needs of a rapidly growing Medicaid population while addressing its own fiscal limitations. We reviewed the Texas Medicaid program, the potential effects of federal healthcare reform, and the state political climate through the perspectives (advantages and disadvantages) of the primary stakeholders: patients, practitioners, hospitals, and insurers. Research was performed through online, federal and state regulatory, and legislative review. In addition, we reviewed government and peer-reviewed reports and articles pertaining to issues related to Medicaid populations, healthcare practitioners, and hospitals that serve them. Each primary stakeholder had potential advantages and disadvantages associated with the expansion of Medicaid managed care. We conclude that expanding Medicaid managed care, if done in a manner responsive to the needs of recipients, can meet enrollees' healthcare needs while controlling the state's costs.
我们着手确定在德克萨斯州扩大医疗补助管理式医疗是否是该州在满足快速增长的医疗补助人群的医疗需求同时应对自身财政限制所面临挑战的解决方案。我们从主要利益相关者（患者、从业者、医院和保险公司）的角度（优点和缺点）审视了德克萨斯州医疗补助计划、联邦医疗改革的潜在影响以及该州的政治氛围。通过在线、联邦和州监管以及立法审查进行了研究。此外，我们还查阅了与医疗补助人群、医疗从业者以及为他们服务的医院相关问题的政府报告和同行评审报告及文章。每个主要利益相关者在医疗补助管理式医疗扩张方面都有潜在的优点和缺点。我们得出结论，以满足受助者需求的方式扩大医疗补助管理式医疗，能够在控制该州成本的同时满足参保人的医疗需求。
