Edgahl R H, Taft C H, Friedland J, Linde K
Ann Surg. 1977 Sep;186(3):388-99. doi: 10.1097/00000658-197709000-00017.
Because hospitalization is a key factor in controlling health care costs and because fee-for-service remains the predominant mode of physician payment, a study was undertaken of the hospitalization experiences of open panel fee-for-service health maintenance organizations (IPA-HMOs) and Foundations for Medical Care (FMCs). Ten open panel plans were surveyed as to characteristics of their programs, physicians, and enrollees and their hospitalization rates. Although data were incomplete, three IPA-HMOs, described as case reports, did achieve striking reductions in hospital use relative to a comparison group or period. Salient characteristics of these plans that may influence hospital use are prepayment by enrollees, sharing by physicians of some financial risk, and effective peer review. Further study is needed, but preliminary indications are that IPA-HMOs have a role to play in reducing health care costs.
由于住院治疗是控制医疗费用的关键因素，且按服务收费仍是医生薪酬的主要支付方式，因此对开放式按服务收费的健康维护组织（独立执业协会型健康维护组织，IPA-HMOs）和医疗保健基金会（FMCs）的住院治疗情况进行了一项研究。对10个开放式计划的项目、医生、参保者特征及其住院率进行了调查。尽管数据不完整，但作为案例报告描述的3个IPA-HMOs相对于对照组或时期确实实现了医院使用的显著减少。这些计划可能影响医院使用的显著特征包括参保者预付费用、医生分担部分财务风险以及有效的同行评审。需要进一步研究，但初步迹象表明，IPA-HMOs在降低医疗费用方面可以发挥作用。
