Sleeper S, Wholey D R, Hamer R, Schwartz S, Inoferio V
Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213-3890, USA. ssaz+@andrew.cmu.edu
J Health Soc Behav. 1998 Sep;39(3):189-200.
This paper examines the factors that influence a Health Maintenance Organization (HMO) to shift risk to doctors through an incentive arrangement called capitation, where physicians are paid a fixed amount per patient for a period of time for any and all medical services required by the patient. Multispecialty-medical-group (Group) HMOs are more likely to shift risk than Independent Physician Associations (IPA) HMOs. Within IPA HMOs, larger enrollment per physician is positively associated with more risk shifting. We find that institutional factors signaling legitimacy play an important role in determining risk shifting. For-profit HMOs are less likely to shift risk, which we interpret as reflecting consumer distrust of for-profit HMOs. However, for-profit HMOs that are federally qualified, which we interpret as a signal of legitimacy, are more likely to shift risk.
本文研究了影响健康维护组织（HMO）通过一种名为按人头付费的激励安排将风险转移给医生的因素。在这种安排下，医生在一段时间内为每位患者所需的任何及所有医疗服务获得固定金额的报酬。多专科医疗集团（集团）型HMO比独立医生协会（IPA）型HMO更有可能转移风险。在IPA型HMO中，每位医生的参保人数越多，与更多的风险转移呈正相关。我们发现，表明合法性的制度因素在决定风险转移方面发挥着重要作用。营利性HMO转移风险的可能性较小，我们将其解释为反映了消费者对营利性HMO的不信任。然而，具有联邦资质的营利性HMO，我们将其视为合法性的信号，则更有可能转移风险。
