van de Ven W P, van Vliet R C, van Barneveld E M, Lamers L M
Department of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
Health Aff (Millwood). 1994 Winter;13(5):120-36. doi: 10.1377/hlthaff.13.5.120.
The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch reforms and of our research concerning risk-adjusted capitation payments. Although we are optimistic about the technical possibilities for solving the problem of cream skimming, the implementation of good risk-adjusted capitation is a long-term challenge.
荷兰正在进行的以市场为导向的医疗保健改革与美国医疗保健中管理式竞争的提议有明显相似之处。在这两个国家，良好的风险调整机制对于改革的成功至关重要，这种机制能够防止“撇脂”行为——即防止保险计划选择健康状况最佳的风险人群。在本文中，我们概述了荷兰的改革以及我们关于风险调整后按人头付费的研究。尽管我们对解决“撇脂”问题的技术可能性持乐观态度，但实施良好的风险调整后按人头付费是一项长期挑战。
