Nestor M S
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Fla., USA.
Arch Dermatol. 1996 Sep;132(9):1099-101.
The American health care system is undergoing a profound reorganization and realignment that is primarily driven by a free-market corporatization of health care. Physicians are extremely concerned that these changes will affect their ability to be autonomous, to retain the free use of their clinical judgment, and finally to be paid adequately. In some instances the changes are already affecting the free choice of ancillary specialties such as dermatopathologists. Indeed, in many areas of the country, managed care is quickly becoming the dominant vehicle for health care delivery and appears in many ways to be affecting physician autonomy for both private practice and academic physicians. Independent practice associations (IPAs) have been developed across the country to meet the needs of managed care cost-effectiveness while attempting to preserve both clinical and financial physician autonomy. This article focuses on dermatology-specific IPAs, including functional models, the potential advantages and disadvantages for individual physicians, and for the specialty, antitrust implications, and finally introduces an IPA model that may benefit dermatologists and the dermatologic community as a whole.
美国医疗保健系统正在经历一场深刻的重组和调整，这主要是由医疗保健的自由市场公司化驱动的。医生们极为担心这些变化会影响他们的自主权、保留临床判断的自由使用权以及最终获得足够报酬的能力。在某些情况下，这些变化已经在影响诸如皮肤病理学家等辅助专科的自由选择。的确，在该国许多地区，管理式医疗正迅速成为医疗保健服务的主导模式，并且在许多方面似乎正在影响私人执业医生和学术医生的自主权。全国各地都成立了独立执业协会（IPA），以满足管理式医疗成本效益的需求，同时试图维护医生在临床和财务方面的自主权。本文重点关注皮肤科特定的IPA，包括功能模式、对个体医生以及该专科的潜在优缺点、反垄断影响，最后介绍一种可能使皮肤科医生和整个皮肤科界受益的IPA模式。
