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アカデミックマネージドケア組織と,テネシー州のメディケイドマネージドケアの下での不利な選択
J E Bailey1, D L Van Brunt, D M Mirvis
1Department of Medicine, University of Tennessee, Memphis 38103, USA. jebailey@utmem.edu
JAMA
|September 24, 1999
まとめ
マネージドケアにおける学術医療センターは,高価な慢性疾患を持つ病気の患者によって不釣り合いに選択されています. この不利な選択は,これらの機関にとって重大な金融リスクをもたらします.
科学分野:
- 医療サービス 研究 医療サービス
- マネージドケア (Managed Care) とは,管理された介護のことです.
- 医療経済学 医療経済学
背景:
- 医療プランは,高コストの登録者による不利な選択によって,財政的なリスクに直面します.
- アカデミック・メディカル・センター (AMC) は,従来より病んでいる患者にサービスを提供しており,マネージドケアでのリスクを増やす.
研究 の 目的:
- AMCを代表するマネージド・ケア・オーガナイゼーション (MCO) が,不良選択を経験しているかどうかを判断する.
- 費用のかかる慢性疾患を持つメディケイドマネージドケア (MMC) の登録者が,AMC関連MCOに不釣り合いに登録しているかどうかを調査します.
主な方法:
- テネシー州メディケイドの請求データ (1994-1995) を用いた観察研究.
- 6つの州別疾患と27の高コストの慢性疾患の比較罹患率を学術,州,地域MCOで比較した.
- 12のMCOで120万人のメディケイド登録者のデータを分析した.
主要な成果:
- アカデミックMCOは,ほとんどの高コストの慢性疾患のより高い罹患率を示しました.
- アカデミックMCOではAIDSの罹患率が14.1倍,凝固不全の罹患率は6.4倍であった.
- 27の追加高コスト条件のうち22の条件は,学術MCOでより一般的であった.
結論:
- アカデミックMCOは,メディケイドマネージドケアにおける最も病気の患者の割合が高く選択されています.
- 負の選択は,管理介護施設のAMCにとって実質的な財務上のリスクをもたらします.
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