Schoenman J A, Evans W N, Schur C L
Project HOPE Center for Health Affairs, Bethesda, MD 20814-6133, USA.
Inquiry. 1997 Summer;34(2):155-70.
A growing number of states are implementing Medicaid managed care programs, and primary care case management (PCCM) is an important component of many of these systems. In this paper, we present results of an evaluation of one such PCCM program--the Maryland Access to Care (MAC) program. The evaluation uses five years of Medicaid claims and eligibility data from the period before and after the program's introduction to determine the program's impact on expenditures and service utilization. Results indicate that the program increased the probability that a Medicaid enrollee would use primary care and preventive services, but had little impact on use of specialty or emergency room services. The gatekeeper program also was successful at controlling expenditures once an enrollee entered the health care system, largely through reductions in the use of ancillary services. The post-MAC increase in the probability of using services was so great, however, that all savings per user were negated, resulting in an estimated increase of about 3.4% in Medicaid expenditures for the MAC-eligible population.
越来越多的州正在实施医疗补助管理式医疗计划，而初级保健病例管理（PCCM）是其中许多系统的重要组成部分。在本文中，我们展示了对一个此类PCCM计划——马里兰州医疗服务获取（MAC）计划的评估结果。该评估使用了该计划引入前后五年的医疗补助理赔和资格数据，以确定该计划对支出和服务利用的影响。结果表明，该计划增加了医疗补助参保人使用初级保健和预防服务的可能性，但对专科或急诊室服务的使用影响不大。一旦参保人进入医疗保健系统，守门人计划在控制支出方面也取得了成功，这主要是通过减少辅助服务的使用来实现的。然而，MAC实施后服务使用概率的增加幅度如此之大，以至于每个用户的所有节省都被抵消了，导致符合MAC资格人群的医疗补助支出估计增加了约3.4%。
