Willemain T R, Mark R B
Med Care. 1980 Apr;18(4):427-41. doi: 10.1097/00005650-198004000-00007.
We propose a new indicator of responsiveness of physician care in nursing homes: the distribution of intervals between physician visits. Current reimbursement and certification practices work to contain costs and assure minimum quality by influencing the intervals between visits. Data from a comparative study of 2 systems of medical care in nursing homes reveal marked differences in the interval distributions of the 2 systems. The system operating under current reimbursement procedures had interval distributions more concentrated around the minimum reimbursable interval. We interpret this concentration as a sign that the reimbursement procedure makes care less responsive to randomly occurring acute episodes by discouraging brief intervals. The interval distributions also document the impact of Medicaid certification standards on longer intervals. A mathematical model of intervals between visits is developed and used to estimate the interval distribution which would obtain in the absence of current reimbursement and certification procedures. This model also describes the distribution of intervals between physician (and dentist) services to noninstitutionalized individuals. These results suggest that such a model might be used in a system of "stochastic regulation" of physician services which would allow physicians greater freedom to respond to patient needs while still permitting public payors to oversee service provision.
医生出诊间隔的分布情况。当前的报销和认证做法通过影响出诊间隔来控制成本并确保最低质量。一项针对疗养院两种医疗护理系统的对比研究数据显示，这两种系统的间隔分布存在显著差异。在现行报销程序下运行的系统，其间隔分布更集中于最低可报销间隔附近。我们将这种集中现象解读为一种迹象，即报销程序通过抑制短暂间隔，使得护理对随机发生的急性发作反应性降低。间隔分布也记录了医疗补助认证标准对较长间隔的影响。我们开发了一个关于出诊间隔的数学模型，并用于估计在没有现行报销和认证程序的情况下会出现的间隔分布情况。该模型还描述了医生（和牙医）为非机构化个体提供服务的间隔分布。这些结果表明，这样的模型可用于医生服务的“随机监管”系统，该系统能让医生有更大的自由来响应患者需求，同时仍允许公共支付方监督服务提供情况。
