Siu A L, Leibowitz A, Brook R H, Goldman N S, Lurie N, Newhouse J P
Health Sciences Program, Rand Corporation, Santa Monica, Calif. 90406-2138.
JAMA. 1988 Mar 4;259(9):1343-6.
Health maintenance organizations (HMOs) achieve their cost savings through lower rates of hospital admissions. To determine whether HMOs selectively avoid discretionary hospitalizations, medical records were reviewed from a randomized trial where families were assigned to either HMO or free-for-service care. Physicians who were blinded to system reviewed 244 medical records and judged the appropriateness both of the hospital setting and of the medical indications for hospitalization. The rate of discretionary surgery was lower in the HMO, while the rate of nondiscretionary surgery was equivalent in the two systems. For medical admissions, rates of discretionary and nondiscretionary admissions were lower in the HMO. There were no observable adverse effects on health from the lower rates of nondiscretionary hospitalization, either because the net effect on health was small or because the HMO substituted appropriate ambulatory services. We conclude that HMO reductions in hospitalization rates do not occur "across the board"; discretionary surgery is selectively avoided.
健康维护组织（HMO）通过降低住院率来实现成本节约。为了确定HMO是否选择性地避免不必要的住院治疗，我们回顾了一项随机试验的病历，在该试验中，家庭被分配到HMO或免费服务护理中。对系统不知情的医生审查了244份病历，并判断了医院环境和住院医疗指征的适宜性。HMO中选择性手术的发生率较低，而在两个系统中，非选择性手术的发生率相当。对于内科住院，HMO中选择性和非选择性住院率均较低。非选择性住院率较低对健康没有明显的不良影响，要么是因为对健康的净影响很小，要么是因为HMO替代了适当的门诊服务。我们得出结论，HMO住院率的降低并非“全面”发生；选择性手术被选择性地避免了。
