Conviser Richard, Gamliel Sandy, Honberg Lynda
Health Care Financ Rev. 1998 Spring;19(3):1-20.
In recent years, State Medicaid programs have begun adopting health-based payment systems to help ensure quality care for people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and to ensure equity for the managed care organizations (MCOs) in which these people are enrolled. In this article, the authors discuss reasons why such payment systems are needed and describe AIDS-specific capitation rates that have been adopted in several State Medicaid waiver programs. The authors also examine comprehensive risk-adjustment systems both within Medicaid and outside the program. Several research questions needing further work are discussed.
近年来，各州医疗补助计划已开始采用基于健康状况的支付系统，以帮助确保为感染人类免疫缺陷病毒（HIV）和获得性免疫缺陷综合征（AIDS）的患者提供优质护理，并确保这些患者参保的管理式医疗组织（MCO）实现公平。在本文中，作者讨论了需要此类支付系统的原因，并描述了几个州医疗补助豁免计划所采用的针对艾滋病的人均费用率。作者还研究了医疗补助计划内部和计划外的综合风险调整系统。文中讨论了几个需要进一步研究的问题。
