理論と実践における独立した実務協会. 経験から学ぶこと
1Bayside Pediatrics, Oakland, CA, USA.
JAMA
|June 28, 1995
まとめ
インディペンデント・プラクティス・アソシエーション (IPA) は,管理ケアにおける医師の自律性を約束しますが,しばしば組織的な権威を優先します. これらのバランスをとることは,医療の未来にとって極めて重要です.
科学分野:
- 健康管理・健康管理について
- 医学経済学 医学経済学
- 組織的行動 組織的行動
背景:
- マネージドケア (Managed Care) は,医療従事者にとって重要な組織的な課題を提示しています.
- サンフランシスコ・イースト・ベイ・エリアは,高度なマネージドケア実装の事例研究として機能しています.
研究 の 目的:
- 医者のマネージドケアに起因する組織的な問題を検討する.
- 独立した実務協会 (IPA) モデルの理論的約束と実践的応用を評価する.
主な方法:
- サンフランシスコ・イースト・ベイ・エリアのマネージド・ケア・ランドスケープ内の組織構造の分析.
- 統合医療計画と直接のゲートキーパーモデルに対するIPAモデルの比較評価.
主要な成果:
- インディペンデント・プラクティス・アソシエーション (IPA) モデルは,理論的には,医師の実践の自律性を維持するために有望である.
- 実際には,イースト・ベイ・エリアの大規模なIPAは,治理,会員,行政における医師の自律性よりも,組織的な権威を好む傾向にあります.
- 実践の自律性を維持することと,IPAの組織的権威との間に緊張がある.
結論:
- 医師の自律性とIPAの権限のバランスをとることは,管理ケアにおける重要な課題です.
- この不均衡を補うために,具体的な政策勧告が必要である.
- 病院や保険会社などの伝統的な機関による支配を防ぐために,医療指導者の積極的な行動は不可欠です.
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