Grogan C M
Yale University, USA.
J Health Polit Policy Law. 1997 Jun;22(3):815-38. doi: 10.1215/03616878-22-3-815.
An Aid to Families with Dependent Children (AFDC)-Medicaid managed care policy consensus has emerged in the American states. Although there are two main organizational forms--primary care case management and risk-based capitation models--states are converging on the risk-based approach for their AFDC recipients. Risk-based Medicaid managed care for AFDC recipients assumes a distinct purpose and meaning. The reform is not just about cost control and improving access but about enduring welfare concerns: deservingness, need, and empowerment. Despite recent federal policies that have essentially severed the eligibility link between AFDC and Medicaid, state policy elites still conceive of poor families on Medicaid as a "welfare" group. Assumptions about the need for behavior modification and the need to integrate this group into "mainstream" America shape perceptions about why Medicaid managed care is appropriate for AFDC-Medicaid recipients.
美国各州已就针对有受抚养子女家庭的援助计划（AFDC）-医疗补助管理式医疗政策达成共识。尽管存在两种主要组织形式——初级保健病例管理和基于风险的按人头付费模式，但各州在为其AFDC受助人采用基于风险的方法上正趋于一致。为AFDC受助人提供基于风险的医疗补助管理式医疗有其独特的目的和意义。这项改革不仅关乎成本控制和改善医疗服务可及性，还涉及持久的福利问题：应得性、需求和赋权。尽管近期联邦政策基本切断了AFDC与医疗补助之间的资格联系，但州政策精英仍将接受医疗补助的贫困家庭视为一个“福利”群体。关于行为矫正的必要性以及将该群体融入“主流”美国的必要性的假设，塑造了对于为何医疗补助管理式医疗适合AFDC-医疗补助受助人的看法。
