Reed S K, Hennessy K D, Mitchell O S, Babigian H M
Department of Psychiatry, University of Rochester, New York.
Hosp Community Psychiatry. 1994 Nov;45(11):1097-103. doi: 10.1176/ps.45.11.1097.
Total monetized and nonmonetized costs and benefits to society of the Monroe-Livingston demonstration project's capitated payment system (CPS) were analyzed.
Total costs and benefits of care for individuals who were prerandomized to an experimental group (of whom about 57 percent were enrolled in the CPS) were compared with those for a control group who received traditional fee-for-service care. Separate two-year results are presented for continuous patients, who were enrolled in a comprehensive CPS plan (N = 201) and for intermittent patients, who were enrolled in a partial plan (N = 155).
All groups showed improvements on many psychosocial measures over the two years. Continuous patients in the experimental group experienced less hospitalization, more case management and transportation services, and higher levels of victimization and were more likely to live in unsupervised settings than continuous patients in the control group. Total annual per patient costs for care of continuous patients ranged from $74,000 to more than $100,000, largely reflecting differences in rates of hospitalization. Experimental subjects in the partial capitation condition differed from the control group in this plan on fewer measures; both groups reported high levels of case management and social support services and relatively lower levels of supervised housing.
The CPS resulted in major improvements in the community's services for persons with serious mental illness and reduced the proportion of care provided in the state hospital.
分析门罗 - 利文斯顿示范项目的按人头付费系统（CPS）对社会的货币化和非货币化总成本及效益。
将预先随机分组到实验组（其中约57%参加了CPS）的个体的护理总成本和效益与接受传统按服务收费护理的对照组进行比较。分别给出了参加全面CPS计划的连续患者（N = 201）和参加部分计划的间歇性患者（N = 155）的两年结果。
所有组在两年内的许多心理社会指标上都有所改善。实验组的连续患者住院次数较少，获得了更多病例管理和交通服务，受害程度较高，并且比对照组的连续患者更有可能生活在无人监管的环境中。连续患者的人均年度护理总成本从74,000美元到超过100,000美元不等，这在很大程度上反映了住院率的差异。部分按人头付费条件下的实验组受试者与该计划中的对照组在较少指标上存在差异；两组都报告了高水平的病例管理和社会支持服务以及相对较低水平的监管住房。
CPS使社区为严重精神疾病患者提供的服务有了重大改善，并减少了州立医院提供护理的比例。
