Mechanic D, Schlesinger M, McAlpine D D
Rutgers University, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ 08903.
Milbank Q. 1995;73(1):19-55.
Managed care (MC) refers to capitated practice (HMOs), utilization management (UM), and programs of case management for persons with mental illness and problems of substance abuse. These approaches differ substantially, and within each type are variations. Management of mental health and substance abuse services is increasingly prevalent, often sharply reducing costs. Savings result from reducing inpatient hospitalization and, sometimes, by substituting less expensive services for more costly ones. Most studies of managed care, however, measure costs narrowly, neglecting shifts in costs to patients, professionals, families, and the larger community. Strategies typical of HMOs and UM may result in lower-quality care for persons with serious mental illness and problems of substance abuse. Studies on this topic are reviewed, an analytic frame of reference is presented, and research needs are defined.
管理式医疗（MC）是指预付费医疗模式（健康维护组织）、利用管理（UM）以及针对患有精神疾病和药物滥用问题者的病例管理项目。这些方法存在显著差异，且每种类型内部也有不同变体。心理健康和药物滥用服务的管理日益普遍，常常大幅降低成本。成本节约源于减少住院治疗，有时还通过用成本较低的服务替代成本较高的服务来实现。然而，大多数关于管理式医疗的研究对成本的衡量较为狭隘，忽略了成本向患者、专业人员、家庭以及更广泛社区的转移。健康维护组织和利用管理的典型策略可能会导致对患有严重精神疾病和药物滥用问题者的护理质量下降。本文对该主题的研究进行了综述，提出了一个分析参考框架，并明确了研究需求。
