Solomon M A
Public Health Rep. 1977 Jul-Aug;92(4):307-14.
The Health Maintenance Organization Act of 1973, the Emergency Medical Services (EMS) Systems Act of 1973, and other laws are examined for their effects on the organization and management of emergency services in prepaid group practice plans (PPGP). The study was conducted in 1974-75 by the Group Health Association of America. The data were gathered through interviews with administrators and providers of seven PPGPs and with leaders of health planning agencies in the same communities, as well as through reviews of internal documents and a 1-month utilization survey of emergency and urgent care services in each PPGP. Effects of the laws were found to be limited, with the health maintenance legislation appearing to have the greastes effect on the design of emergency servide models. In most localities, two parallel systems may operate in offering round-the-clock emergency care and programs to educate members and the public about the appropriate use of emergency facilities. The EMS legislation has had minimal effects on the design of emergency services in the PPGPs. The emergency services component is the most transitional aspect of the PPGS nad the one most amenable to change. Revisions have come through changes in internal management policy and from demands of subscribers. A regulating inference in the operation of the PGP, in the area of emergency services as well as in the delivery of primary care services, is that the plans must compete, both in costs and benefits, with available indemnity insurance coverage. The market dictates premium levels without regard to associated benefits. Additional costs for broader coverage and administrative regulatory mechanisms must be borne by the subscriber in the form of increased premiums. As a result, the utilization of expensive emergency care must be carefully controlled, and this restraint is often accomplished by requirements specifying which health problems are appropriate for the provision of emergency care, rather than by delaying assistance until the plan's office hours. The furtherance of the PPGP concept, that the entire health care of the individual person is provided and financed by one organization, definancedby one organization, detracts from the viability of a central body charged with the coordination of the delivery of all emergency services in the community. It results not only in duplication of effort but often in the establishment of potentially antagoistic organizations.
对1973年的《健康维护组织法案》、1973年的《紧急医疗服务（EMS）系统法案》以及其他法律对预付团体医疗计划（PPGP）中紧急服务的组织和管理所产生的影响进行了研究。该研究由美国团体健康协会于1974 - 1975年开展。数据通过对七个PPGP的管理人员和提供者以及同一社区健康规划机构的负责人进行访谈收集，同时还通过审查内部文件以及对每个PPGP的紧急和紧急护理服务进行为期1个月的使用情况调查来获取。发现这些法律的影响有限，其中健康维护立法似乎对紧急服务模式的设计影响最大。在大多数地区，可能会有两个并行系统在提供全天候紧急护理以及开展教育成员和公众合理使用紧急设施的项目方面发挥作用。EMS立法对PPGP中紧急服务的设计影响甚微。紧急服务部分是PPGP中最具过渡性的方面，也是最易于变革的方面。修订源于内部管理政策的变化以及订阅者的需求。在PPGP的运营中，在紧急服务领域以及初级护理服务的提供方面，一个规范性的推断是，这些计划必须在成本和效益方面与现有的赔偿保险进行竞争。市场决定保费水平而不考虑相关福利。更广泛保险范围和行政监管机制的额外成本必须由订阅者以提高保费的形式承担。因此，必须谨慎控制昂贵的紧急护理的使用，这种限制通常通过规定哪些健康问题适合提供紧急护理来实现，而不是通过推迟援助直到计划的办公时间。PPGP概念的推进，即个人的整个医疗保健由一个组织提供并资助，削弱了负责协调社区所有紧急服务提供的中央机构的可行性。这不仅导致了工作的重复，而且常常导致建立潜在对立的组织。
