Fuller N A, Patera M W, Koziol K
Med Care. 1977 Sep;15(9):705-37. doi: 10.1097/00005650-197709000-00001.
To provide medical service at lower costs without diminishing either quality or coverage, the District of Columbia enrolled approximately 1,000 Medicaid beneficiaries, voluntarily, in a prepaid group practice (PGP). The project was evaluated over a three-year period (1971-1974) with regard to: 1) rate of utilzation of medical care before and after enrollment; 2) costs of care per capita as compared with those of the 160,000 beneficiaries in the Medicaid fee-for-service universe; and 3) patient satisfaction with the PGP. Results indicate that for the 834 individuals aged 1 through 64 enrolled in the PGP; ambulatory physican encounter rates decreased 15 per cent, drug utilization was down 18 per cent, hospital admissions decreased 30 per cent, and hospital days declined 32 per cent after enrollment. For the same benefit package, annual prepaid per capita costs for the Medicaid PGP enrollees for 1972, 1973, 1974 were only +282, +232, and +286 respectively, representing a 37 per cent saving when compared to the fee-for-service per capita costs of the Medicaid Universe which stood of +373, +435 and +465 over the same period. The instrument used to probe patient satisfaction showed the Study Group was satisfied with the PGP, and received better dental care. The voluntary dropout rate from the PGP was only 2.5 per cent; and out-of-plan utilization was low, indicating good acceptance of the PGP service.
为了在不降低医疗质量和覆盖范围的前提下降低医疗服务成本，哥伦比亚特区自愿让约1000名医疗补助受益人加入了一个预付团体医疗模式（PGP）。该项目在三年期间（1971年至1974年）进行了评估，评估内容包括：1）加入前后的医疗服务利用率；2）与医疗补助按服务收费体系中的160000名受益人相比的人均医疗成本；3）患者对PGP的满意度。结果表明，对于加入PGP的834名年龄在1岁至64岁之间的个体，加入后门诊医生诊疗率下降了15%，药物使用率下降了18%，住院人数下降了30%，住院天数下降了32%。对于相同的福利套餐，1972年、1973年、1974年医疗补助PGP参保人的年度人均预付费用分别仅为282美元、232美元和286美元，与同期医疗补助体系按服务收费的人均成本373美元、435美元和465美元相比，节省了37%。用于调查患者满意度的工具显示，研究组对PGP感到满意，并且获得了更好的牙科护理。PGP的自愿退出率仅为2.5%；计划外利用率较低，表明PGP服务得到了很好的接受。
