1980年以来,管理されたケアプランのパフォーマンスを管理しています. 文献の分析を行いました
1University of California-San Francisco, Institute for Health & Aging 94143.
JAMA
|May 18, 1994
まとめ
ヘルスメンテナンス・オーガニゼーション (HMO) などのマネージド・ケア・プランでは,賠償プランよりも病院利用が少なく,予防サービスの利用が多くなっています. しかし,サービスに対する参加者の満足度は低いが,コストに対する満足度は高い.
科学分野:
- 医療サービス 研究 医療サービス
- 比較効果研究 比較効果研究
- 健康経済学 医療経済学
背景:
- マネージドケアプランは1980年以来大きく進化してきました.
- 損害賠償プランは,健康保険に対する伝統的なアプローチを表しています.
- 計画のパフォーマンスの違いを理解することは,政策立案者や消費者にとって極めて重要です.
研究 の 目的:
- 医療利用,支出,医療の質を比較し,マネージドケアと補償プランの満足度を比較する.
- 異なるマネージドケアモデルのパフォーマンスの証拠を統合する.
主な方法:
- 1980年以降の研究に関する体系的な文献レビュー.
- 比較グループに民間保険およびメディケア加入者を含める.
- 登録者の特徴に統計的調整を施したピアレビューされた研究に焦点を当てます.
主要な成果:
- ヘルスメンテナンス・オーガニゼーション (HMO) は,補償金プランと比較して,入院率が低く,入院期間も短くなっています.
- HMOは,予防サービスの利用が増加し,高価な手続きの利用が減少していることを示しています.
- HMOでは,サービスに対する受験者の満足度は低いが,コストに対する満足度は高い.
結論:
- マネージド・ケア・プランは,補償金・プランとは異なる利用パターンを示しています.
- 特定のマネージドケア組織構造 (例えば,スタッフモデルとIPAモデル) の優位性を強く支持する証拠はありません.
- 一般化は,測定されていない選択バイアス,計画構造の進化,市場動態のために注意が必要です.
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