Kronick R, Zhou Z, Dreyfus T
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093, USA.
Inquiry. 1995 Spring;32(1):41-55.
This article explores how to reward health plans that serve people with disabilities and residents of low-income areas. We analyze health care expenditure patterns for Medicaid-covered persons with disabilities in Ohio, Missouri, Minnesota, and Wisconsin, demonstrating that diagnostic classifications are predictably related to resource utilization, and that health care expenditures are much more predictable for persons with disabilities than for the nondisabled. The implications of this analysis for risk-adjusted payment systems are explored. We also consider methods of assuring that health plans will provide high-quality care to the residents of inner city neighborhoods.
本文探讨如何奖励为残疾人士和低收入地区居民提供服务的健康保险计划。我们分析了俄亥俄州、密苏里州、明尼苏达州和威斯康星州医疗补助覆盖的残疾人士的医疗保健支出模式，表明诊断分类与资源利用存在可预测的关联，并且残疾人士的医疗保健支出比非残疾人士更具可预测性。我们还探讨了这一分析对风险调整支付系统的影响。我们也考虑了确保健康保险计划为市中心社区居民提供高质量护理的方法。
