McClure W
Inquiry. 1984 Fall;21(3):205-13.
Capitation as an alternative to traditional charge and cost reimbursement has been a serious policy issue since at least 1970, and is currently one of the most seriously debated and far-reaching health issues before Congress. Nonetheless, the research effort on risk-adjusted per capita payment has been meager. In this overview, the author points out the pitfalls of prior utilization as a basis for capitation rates. He suggests instead that a capitation risk adjustment system be developed that eliminates cost variation resulting from patient risk but not that resulting from provider inefficiency, and that risk values across groups be normalized to prevent "risk group creep" and to ensure budget neutrality. He concludes that because obstacles were overcome in developing the current per admission DRG system for Medicare, the same can be done for a capitation system, and makes specific suggestions for doing so.
至少自1970年以来，作为传统收费和成本报销替代方案的按人头付费一直是一个严重的政策问题，目前是国会面临的最受激烈辩论且影响深远的健康问题之一。尽管如此，针对风险调整后的人均支付的研究工作却很薄弱。在本综述中，作者指出了将既往医疗服务利用率作为按人头付费率依据的缺陷。相反，他建议建立一种按人头付费风险调整系统，该系统要消除因患者风险导致的成本差异，但不消除因医疗服务提供者效率低下导致的成本差异，并且要对各群体的风险值进行标准化，以防止“风险群体蔓延”并确保预算中立。他总结称，由于在为医疗保险开发当前的按病种付费（DRG）系统时克服了种种障碍，所以为按人头付费系统也能做到同样的事，并为此提出了具体建议。
