メリーランド州の経験と, ambulatory primary careにおける既存のモデルを拡張するための実用的な提案
W A Riley1, W A Schneckenburger
1Department of Medicine, Greater Baltimore Medical Center, MD 21204.
JAMA
|August 28, 1991
まとめ
メリーランド メリーランド メリーランド メリーランド
科学分野:
- 健康経済学 医療経済学
- 保健医療政策について
- プライマリケアモデル プライマリケアモデル
背景:
- メリーランド州には,未保険者および未十分な保険者のための2つの異なる医療サービス提供モデルが存在します.
- 一つのモデルは,メディケア免除付きのプライマリケアグループ・プラクティスであり,患者と医師に利益をもたらします.
- 2つ目は,入院医療施設のための,全納付者の将来の料金設定システムである,金融モデルです.
研究 の 目的:
- メリーランド州の2つのユニークなヘルスケア・ファイナンシング・アンド・デリバリー・モデルの成功を分析する.
- 2つの既存のシステムの強みを統合した統合モデルを提案する.
- 実践的かつ政治的に実現可能な医療ソリューションを作成する.
主な方法:
- グループ・プラクティスのレビュー, ambulatory Medicare waiverを持つプライマリケアモデル.
- すべての納入者の将来的な利率設定システムからの13年間の財務データ (1977年−1989年) の分析.
- 新しい提案を参考にするために,各モデルの成功要因の議論.
主要な成果:
- プライマリケアモデルは,患者と医師にポジティブな影響を与えました.
- オール・ペイヤー・システムは,1977年から1989年の間にメリーランド州市民に5361億ドルの節約をもたらした.
- 病院は慈善事業と不良債権で1657億ドルを寄付し,利益は5億1,700万ドルとなった.
結論:
- 両方のモデルの成功は,それらのユニークな構造に起因する.
- 2つのモデルの最良の側面を統合する提案が行われます.
- 推奨されるモデルは, ambulatory primary care-basedであり,すべての支払者による将来的な料金システムによって資金提供されます.
関連する概念動画
01:26Methods Of Healthcare Delivery System
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:30Primary Healthcare Services
Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:25Models of Health Promotion and Illness Prevention I
A model is a theoretical way to understand a concept or an idea. Models can overcome barriers to health regardless of diverse economic and cultural backgrounds. In addition, models make the task easier by providing different ways to approach complex issues. There are two major health promotion models: the health belief model and the health promotion model.
The health belief model (HBM) attempts to predict health-related behavior in specific belief patterns. According to the HBM, a person's...
The health belief model (HBM) attempts to predict health-related behavior in specific belief patterns. According to the HBM, a person's...
01:13Patient-centered Care
Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...
01:15Methods of Documentation VI: Case Management Model
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
For example, a patient with a chronic illness...
01:29Documentation in Long-Term and Home Healthcare Setting
Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Long-Term Care Facilities