Lawrence P. Casalino (
Health Aff (Millwood). 2017 May 1;36(5):865-869. doi: 10.1377/hlthaff.2016.1536.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may accelerate the movement of physicians into corporate employment by hospitals and, to a lesser extent, by health insurers and other corporations. This article briefly summarizes the demographics of US physician practice, the potential advantages and disadvantages of physician employment by large corporations, and the evidence to date on the performance of large versus small physician practices and hospital-employed versus independent physicians. It describes the features of MACRA likely to lead physicians to seek corporate employment and the steps the Centers for Medicare and Medicaid Services has taken through MACRA to aid small independent physician practices. I conclude that MACRA's net effect is likely to be accelerated corporate employment of physicians and that there is an urgent need for more evidence on the impact of different types of provider organization on the quality and cost of care, and on patient, physician, and staff experience.
2015 年《平价医疗法案》（MACRA）可能会加速医生进入医院（以及在较小程度上进入医保公司和其他公司）的企业雇佣模式。本文简要总结了美国医生执业的人口统计学特征、大公司雇佣医生的潜在优缺点，以及目前有关大、小医生执业和医院雇佣医生与独立医生之间绩效的证据。本文还介绍了 MACRA 中可能促使医生寻求企业雇佣的特征，以及医疗保险和医疗补助服务中心为帮助小型独立医生执业而在 MACRA 中采取的措施。我得出的结论是，MACRA 的净效应可能是加速医生的企业雇佣，并且迫切需要更多有关不同类型医疗机构组织对医疗质量和成本、患者、医生和员工体验的影响的证据。
