Weil P A
Milbank Mem Fund Q Health Soc. 1976 Summer;54(3):339-65.
This research was conducted in order to compare costs to the Medicare program for providing health care service to old people enrolled in two forms of health delivery organization: open market and prepaid group practice (pgp). Two data sources were employed: cost data provided by the Social Security Administration for seven prepaid group practices in five SMSAs and northern California and interviews conducted with administrators of the prepaid groups to determine: organizational sponsorship, incentive structure, pattern of selectivity of patients, and resource availability. Major findings are: (1) Enrollees in prepaid groups incur higher physician costs. This includes services provided by practitioners in and outside the plans. (2) Overall, prepaid groups demonstrate savings to the Medicare program in provider-initiated services- in hospital care and extended care facility services, but not in home health care. (3) Reduced spending in the hospital component does not imply reduction in the extended care facility or home service. (4) Outpatient costs in the hospital are generally higher in the open market modes, probably because this mode of care is viewed as an alternative to physician visits. (5) The greatest cost savings to the Medicare program are demonstrated by groups which are relatively small, yet hospital-based.
开展这项研究是为了比较医疗保险计划为参加两种医疗服务提供组织形式（开放市场和预付团体医疗模式）的老年人提供医疗服务的成本。使用了两个数据源：社会保障管理局提供的五个标准都市统计区和北加利福尼亚州七个预付团体医疗模式的成本数据，以及与预付团体管理人员进行的访谈，以确定：组织赞助、激励结构、患者选择模式和资源可用性。主要发现如下：（1）预付团体医疗模式的参保人产生的医生成本更高。这包括计划内和计划外从业者提供的服务。（2）总体而言，预付团体医疗模式在医院护理和长期护理机构服务等由医疗服务提供者发起的服务方面为医疗保险计划节省了费用，但在家庭医疗保健方面没有节省。（3）医院部分支出的减少并不意味着长期护理机构或家庭服务支出的减少。（4）在开放市场模式下，医院门诊成本通常较高，这可能是因为这种护理模式被视为医生诊疗的替代方式。（5）对医疗保险计划成本节省最多的是规模相对较小但以医院为基础的团体。
