管理护理和医生提供慈善护理
P J Cunningham1, J M Grossman, R F St Peter
1Center for Studying Health System Change, Washington, DC 20024, USA. PJC@hschange.com
JAMA
|April 3, 1999
概括
管理护理计划中的医生提供更少的慈善护理. 一个地区的高管理护理透率也减少了医生慈善护理时间,影响了无保险患者的获取.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医生实践模式的模式
- 医疗保健政策 医疗保健政策
背景情况:
- 卫生系统的变化可能会限制医生提供无偿护理的能力.
- 这可能会降低无保险和低保险人群的医生准入.
研究的目的:
- 研究管理护理参与与医生提供慈善护理之间的关系.
- 了解管理护理如何影响弱势患者群体的医生可用性.
主要方法:
- 利用了1996-1997年社区追踪研究医生调查的数据.
- 分析了60个社区10881名医生的全国代表样本.
- 以医生因患者的财务需要而提供免费或低费护理的小时数来衡量慈善护理.
主要成果:
- 77.3%的医生每月平均提供10.3小时的慈善护理.
- 管理护理收入高的医生 (≥85%) 提供慈善护理的可能性明显较低.
- 在一个地理区域的高管理护理透率与较少的慈善护理小时相关,不管个人医生参与 (P<.01).
- 一个人和两名医生的诊所提供了比其他安排更多的慈善护理 (P<.01).
结论:
- 医生参与管理护理与减少慈善护理提供有关.
- 高区域管理护理的透率进一步降低了医生慈善护理的可用性.
- 这些发现表明,管理护理可能会加剧未保险患者的接入问题.
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