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网络人头费计划:运营视角

Network capitation plans: an operational perspective.

作者信息

Calkins D H, Turner L T, Brady R J

出版信息

Dent Clin North Am. 1987 Apr;31(2):209-23.

PMID:3471579
Abstract

Dentistry's mission has been defined as improving the oral health of the public. In the ADA's report on the strategic plan for dentistry, the first priority addressed is to convert public unmet needs into a demand for dental services. One of the methods which the plan has outlined for action is to "expand dental prepayment and promote growth of innovative payment mechanisms." The prepaid capitation method of payment can and will provide a vehicle to service those unmet needs. Healthcare insurance companies are organizing regional and national networks of individual practices who will accept this method of prepayment. As in all systems of delivery, there are possibilities for abuse. This article addresses a prepaid capitation delivery system from an operational perspective, in order to identify the elements that should safeguard the patient, dentist, employer group, and carrier.

摘要

牙科的使命被定义为改善公众的口腔健康。在ADA关于牙科战略计划的报告中,首要解决的问题是将公众未满足的需求转化为对牙科服务的需求。该计划概述的行动方法之一是“扩大牙科预付费并促进创新支付机制的发展”。预付费按人头支付的方法能够而且将会提供一种满足那些未满足需求的途径。医疗保险公司正在组织个体医疗机构的区域和全国性网络,这些机构将接受这种预付费方式。与所有医疗服务提供系统一样,存在滥用的可能性。本文从运营角度探讨预付费按人头支付的医疗服务提供系统,以确定应保护患者、牙医、雇主团体和承保人的要素。

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