Frazier S, Hyman D, Altschuler S
Children's Health Net, Philadelphia, Pennsylvania 19104, USA.
Pediatrics. 1998 Apr;101(4 Pt 2):795-803; discussion 803-4.
Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.
在美国各地，管理式医疗的发展正迫使儿科医疗服务提供者（医生和医院）重建并整合医疗服务体系，将重点从学术中心转向社区。管理式医疗还促使采用新的融资方式，以承担患者管理和服务利用方面的经济风险。为了适应因这些不断演变的市场力量而进行的战略和运营变革，儿科培训项目必须进行彻底改革。这些变革虽然具有颠覆性，但将加强毕业后医学教育的广度和多样性，并使受训人员更好地为他们即将执业的新医疗服务体系做好准备。在本文中，我们探讨管理式医疗的演变如何重新定义儿科医疗的基本财务和组织框架，以及这种重新定义对儿童医院和基于学术医疗中心的儿科项目的影响。我们借鉴在大费城地区市场的经验来说明这些变化的影响，并讨论一个儿科系统的应对措施。最后，我们审视这些变化带来的教育机会。
