Colenda C C, Sherman F T
Department of Psychiatry, Michigan State University College of Human Medicine, East Lansing, USA.
Geriatrics. 1998 Jan;53(1):57-63; quiz 64.
Medicare is looking to managed care to help solve its financial burden. Because managed care plans offer a number of advantages for Medicare enrollees, the number of plans and of enrollees are increasing dramatically. With some exceptions, the Medicare population appears to do as well or better in HMOs as in fee-for-service care, despite differences in utilization of services. For the primary care physician, the key to success in managed Medicare is finding and aggressively managing your frail or near frail patients. Basic tools for survival are the use of prevention strategies, screening of enrollees and targeting for needed services, geriatric assessment, use of alternate care settings to avoid or limit costly hospital care, and monitoring of medication use for compliance and adverse reactions.
医疗保险正在寻求管理式医疗来帮助解决其财政负担。由于管理式医疗计划为医疗保险参保人提供了许多优势，此类计划和参保人的数量都在急剧增加。尽管服务利用情况存在差异，但除了一些例外情况，医疗保险人群在健康维护组织（HMO）中的表现似乎与按服务收费医疗中的表现相当或更好。对于初级保健医生来说，在管理式医疗保险中取得成功的关键是找到并积极管理体弱或接近体弱的患者。生存的基本工具包括使用预防策略、对参保人进行筛查并针对所需服务、进行老年评估、使用替代护理环境以避免或限制昂贵的住院治疗，以及监测药物使用的依从性和不良反应。
