Wetzler S, Schwartz B J, Sanderson W, Karasu T B
Division of Psychology, Albert Einstein College of Medicine, Monteflore Medical Center, Bronx, NY 10467, USA.
Psychiatr Serv. 1997 Aug;48(8):1019-26. doi: 10.1176/ps.48.8.1019.
An academic department of psychiatry in New York City eliminated the need for behavioral managed care intermediaries by transforming itself from a fee-for-service system to a system able to engage in full-risk capitation contracts. The first step was to require health maintenance organizations to contract directly with the department. The department formed two legal entities, a behavioral management services organization for utilization management and a behavioral integrated provider association. The authors describe these entities and review the first year of operation, presenting data on enrollees, capitation rates, and service utilization for the first three contracts. The fundamental differences in the treatment model under managed care and under a fee-for-service system are highlighted. The authors conclude that by contracting directly with insurers on a full-risk capitation basis, departments of psychiatry will be better able to face the economic threats posed by the cost constraints inherent in managed care and maintain or re-establish their autonomy as care managers as well as high-quality care providers.
纽约市的一个精神科系通过将自身从按服务收费系统转变为能够签订全风险人头合同的系统，消除了对行为管理式医疗中介机构的需求。第一步是要求健康维护组织直接与该系签订合同。该系组建了两个法律实体，一个用于利用管理的行为管理服务组织和一个行为综合提供者协会。作者描述了这些实体，并回顾了运营的第一年，呈现了前三份合同的参保人、人头费率和服务利用情况的数据。强调了管理式医疗和按服务收费系统下治疗模式的根本差异。作者得出结论，通过在全风险人头基础上直接与保险公司签订合同，精神科系将能够更好地应对管理式医疗固有成本限制带来的经济威胁，并作为护理管理者以及高质量护理提供者维持或重新确立其自主权。
