学术管理护理组织和医疗补助管理护理的不利选择在田纳西州
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Updated: Aug 4, 2026

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Models of Bone Metastasis
Published on: September 4, 2012
J E Bailey1, D L Van Brunt, D M Mirvis
1Department of Medicine, University of Tennessee, Memphis 38103, USA. jebailey@utmem.edu
JAMA
|September 24, 1999
概括
管理护理的学术医疗中心被昂贵的慢性病症患者不成比例地选择. 这种不利的选择给这些机构带来了重大的财务风险.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 管理护理管理护理
- 医疗保健经济学 医疗保健经济学
背景情况:
- 医疗计划面临的财务风险来自高成本的注册人的不利选择.
- 学术医疗中心 (AMC) 传统上为更生病的患者提供服务,增加了他们在管理护理中的风险.
研究的目的:
- 确定代表AMC的管理护理组织 (MCO) 是否经历了不良选择.
- 调查是否医疗补助管理护理 (MMC) 登记者与昂贵的慢性疾病不成比例地注册在AMC附属的MCOs.
主要方法:
- 使用田纳西州医疗补助申请数据 (1994-1995) 的观察性研究.
- 在学术,全州和区域MCO中比较了6种国家特定的和27种额外的高成本慢性疾病的患病率.
- 分析了12个资本化MCO的120万医疗补助注册人的数据.
主要成果:
- 学术MCO显示,大多数高成本慢性疾病的患病率更高.
- 在学术MCO中,艾滋病的患病率是学术MCO的14.1倍;凝血缺陷是6.4倍.
- 在27个额外的高成本条件中,22个在学术MCO中更为普遍.
结论:
- 学术MCOs是由医疗补助管理护理中较高比例的最病患者选择的.
- 负面选择对管理护理机构的AMC带来了巨大的财务风险.
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