マネージドケア組織によるプライマリケア医師の選択と排除
A B Bindman1, K Grumbach, K Vranizan
1Primary Care Research Center, Division of General Internal Medicine, San Francisco General Hospital, University of California, 94110, USA. bindman@itsa.ucsf.edu
JAMA
|March 13, 1998
まとめ
マネージドケア契約の拒否や解約は,医師にとって一般的ですが,ほとんどの人は依然としてマネージドケアに参加することができます. 選択的契約は,医療サービスが不足している人群に奉仕する医師を不利にすることがあります.
科学分野:
- 医療サービス 研究 医療サービス
- 契約医の医師について
- マネージド・ケア・ネットワーク
背景:
- マネージドケアネットワークへのアクセスにおける医師の課題に関する理解は限られている.
- マネージドケアプランによる医師選択における差別的慣行に関する不確実性.
研究 の 目的:
- 医師契約の拒否または終了の発生率と予測要因を調査する.
- これらの契約変更がプライマリケア医師のマネージドケアへの関与に与える影響を評価する.
主な方法:
- カリフォルニアのプライマリケア医の横断的な郵便調査.
- 独立診療協会 (IPA) や健康維持機関 (HMO) との契約の拒否/解約の分析.
主要な成果:
- 医師の22%は契約の拒否/終了を経験し,87%は少なくとも1つの契約を持っていた.
- ソロ・プラクティスは,拒否/解約と契約の欠如の予測要因でした.
- マネージドケアにおける医師は,保険のない患者や非白人患者を少なく診察した.
結論:
- 契約の拒否/終了は一般的ですが,ほとんどの医師がマネージドケアへの参加を妨げることはありません.
- 選択的契約は,医師の特徴によって,体系的に差別的であってはならない.
- 医療サービスが不足している集団に奉仕する医師に対する潜在的なバイアスが存在します.
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