Garfield S R, Collen M F, Feldman R, Soghikian K, Richart R H, Duncan J H
N Engl J Med. 1976 Feb 19;294(8):426-31. doi: 10.1056/NEJM197602192940806.
We designed a medical-care-delivery system specifically to relieve the impaired access to care that has invariably assompanied the elimination of personal fees by prepaid plans, Medicare and other third-party payment plans. The solution involved the entry of patients through a paramedically staffed health-evaluation servece that effectively separated patients into three basic health-status groups-the well and worried well (68.4 per cent); the asymptomatic sick (3.9 per cent); and the sick (27.7 per cent)--a process that permitted matching the needs of each group with appropriate services. The system achieved increased physician accessibility to new patients by 20 times, reduced the waiting time for new appointments from six to eight weeks to a day or two, saved physician time and costs for entry work to a day or two, saved physician time and costs for entry work-up by 70 to 80 per cent reduced total resources used throughout the year by +32,550 per 1000 entrants, and proved very satisfactory to patients and generally so to staff.
我们设计了一种医疗服务提供系统，专门用于缓解因预付费计划、医疗保险和其他第三方支付计划取消个人费用而导致的医疗服务获取不便问题。解决方案包括让患者通过配备医护人员的健康评估服务机构就诊，该机构有效地将患者分为三个基本健康状况组：健康且担忧健康的人群（68.4%）；无症状患病者（3.9%）；患病者（27.7%）。这一过程能够使每个组的需求与适当的服务相匹配。该系统使医生接待新患者的可及性提高了20倍，将新预约的等待时间从六到八周缩短至一两天，将医生进行初诊工作的时间和成本节省至一两天，将医生进行初诊检查的时间和成本降低了70%至80%，每1000名新患者全年使用的总资源减少了32550，并且患者对该系统非常满意，工作人员总体上也很满意。
