Eng T R
Division of Health Promotion and Disease Prevention, Institute of Medicine, Washington, DC 20418, USA.
Am J Prev Med. 1999 Jan;16(1):60-9. doi: 10.1016/s0749-3797(98)00090-7.
The growth of managed care has spurred re-evaluation of the roles and responsibilities of public health agencies and private health plans for providing public health services. Although rates of curable sexually transmitted diseases (STDs) in the United States are the highest in the developed world, many clinicians and managed care organizations are not systematically providing high-quality, comprehensive STD-related services to their patients and the community.
To examine issues around managed care and STD prevention as a model for overcoming barriers that impede managed care organizations from providing comprehensive public health services and collaborating with health agencies.
Two-day invitational workshop.
Representatives from 18 health plans, 10 public health agencies, 6 academic institutions, 1 purchasing coalition, and 5 other health organizations.
Major obstacles include: turnover and heterogeneity in the health care system; deficiencies in clinical knowledge and skills; differences in organizational culture and language; low priority of STDs; inadequate public health surveillance data and performance measures; confidentiality concerns; and lack of coverage for sex partners.
Potential approaches for addressing these barriers include: requiring that STD-related services be covered by Medicaid managed care programs; implementing performance measures; requiring collaborative activities; promoting education of and outreach to stakeholders; funding of pilot projects; and researching the cost-benefit and cost-effectiveness of STD-related services for various populations.
管理式医疗的发展促使人们重新审视公共卫生机构和私人健康计划在提供公共卫生服务方面的角色和责任。尽管美国可治愈性传播疾病（STD）的发病率在发达国家中是最高的，但许多临床医生和管理式医疗组织并未系统地为其患者和社区提供高质量、全面的性传播疾病相关服务。
探讨围绕管理式医疗和性传播疾病预防的问题，以此作为克服阻碍管理式医疗组织提供全面公共卫生服务及与卫生机构合作的障碍的一个范例。
为期两天的邀请研讨会。
来自18家健康计划机构、10家公共卫生机构、6家学术机构、1个采购联盟以及5家其他卫生组织的代表。
主要障碍包括：医疗保健系统中的人员流动和异质性；临床知识和技能的不足；组织文化和语言的差异；性传播疾病的优先级较低；公共卫生监测数据和绩效指标不足；对保密性的担忧；以及性伴侣保险覆盖不足。
解决这些障碍的潜在方法包括：要求医疗补助管理式医疗计划涵盖性传播疾病相关服务；实施绩效指标；要求开展协作活动；促进对利益相关者的教育和宣传；为试点项目提供资金；以及研究针对不同人群的性传播疾病相关服务的成本效益和成本效果。
