Welch W P, Welch H G
Urban Institute, Washington, DC, USA.
Health Aff (Millwood). 1995 Winter;14(4):104-16. doi: 10.1377/hlthaff.14.4.104.
This paper outlines a simple proposal to maintain utilization data in the face of managed care growth. Health maintenance organizations (HMOs) would be required to submit claims (encounter-level data) and in return would be paid a percentage of what Medicare would pay fee-for-service providers. The capitation payment rate would be lowered to maintain budget-neutrality. This proposal would enable the collection of key data that might not otherwise be captured in a Medicare program dominated by HMOs and other forms of managed care. The data are necessary to drive Medicare policies and to gauge the impact of changes to the program. The program would be well advised to make the small additional investment to make the data system complete. The key issue in implementing such a proposal will be HMOs' ability to generate those data at reasonable cost.
本文概述了一项在管理式医疗增长的情况下维持利用数据的简单提议。健康维护组织（HMO）将被要求提交索赔（就诊级数据），作为回报，它们将获得医疗保险按服务收费支付给提供者金额的一定比例。人头费支付率将降低以维持预算中立。该提议将能够收集关键数据，否则这些数据可能无法在由HMO和其他形式的管理式医疗主导的医疗保险计划中获取。这些数据对于推动医疗保险政策以及评估该计划变化的影响是必要的。该计划最好进行少量额外投资以使数据系统完整。实施这样一项提议的关键问题将是HMO以合理成本生成这些数据的能力。
