概括
医疗保险资本化融资示范显示,由于偿还不足,造成了重大财务损失. 调整后的人均平均成本方法未能考虑关键的风险因素,最终证明无法有效提供医疗保健.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 公共卫生 公共卫生
背景情况:
- 1982年"税收公平和财政责任法案"为健康维护组织 (HMO) 和竞争性医疗计划 (CMP) 引入了医疗保险风险投资融资.
- 为了测试这种融资模式,实施了示范项目.
- 1985年1月,最终法规发表于1985年1月.
研究的目的:
- 评估医疗保险风险资本化融资的财务可行性和运营挑战.
- 评估调整平均人均成本 (AAPCC) 偿还方法的有效性.
主要方法:
- 在威斯康星州马什菲尔德进行了为期28个月的示范项目的分析.
- 检查入学数据,财务表现和医院利用率.
- 审查报销机制及其对计划成本的影响.
主要成果:
- 马什菲尔德示威造成的总损失超过300万美元 (11.6%的收入).
- 尽管使用情况严格审查,住院日数减少,但联邦政府补偿不足.
- 在居民受益者中,入学率达到37%.
结论:
- 调整后的平均人均成本补偿方法不足以解决招生选择,未满足的医疗需求和区域成本差异.
- 根据医疗保险风险合同,估计的服务费用95%的退款不足以维持高效的医疗保健服务系统.
- 由于财务不可持续性,示范项目被终止.
相关概念视频
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Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
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Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
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Healthcare Agencies II
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Methods of Documentation VI: Case Management Model
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
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Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Long-Term Care Facilities


