Frank R G, McGuire T G, Newhouse J P
Department of Health Care Policy, Harvard University, USA.
Health Aff (Millwood). 1995 Fall;14(3):50-64. doi: 10.1377/hlthaff.14.3.50.
Private employers and state Medicaid programs are increasingly writing risk contracts with managed behavioral health care companies to manage mental health and substance abuse benefits. This paper analyzes the case for a carve-out program and makes recommendations about the form of the payer-managed behavioral health care contract. Payers should consider using a "soft" capitation contract in which only some of the claims' risk is transferred to the managed behavioral health care company. To avoid incentives to underserve seriously ill persons, we recommend that payers not allow choice by enrollees among risk contractors.
私营雇主和州医疗补助计划越来越多地与管理式行为健康护理公司签订风险合同，以管理心理健康和药物滥用福利。本文分析了设立独立项目的理由，并就付款人管理的行为健康护理合同的形式提出建议。付款人应考虑使用“软”人头合同，即仅将部分索赔风险转移给管理式行为健康护理公司。为避免产生为病情严重者提供不足服务的动机，我们建议付款人不允许参保人在风险承包商之间进行选择。
