管理护理组织对初级保健医生的选择和排除
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
对医生来说,管理护理合同的拒绝和终止是常见的,但大多数人仍然可以参与管理护理. 选择性合同可能会使服务不足的人群的医生处于不利地位.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 签约医生 签约医生 签约医生
- 管理护理网络管理护理网络
背景情况:
- 对医生在获取管理护理网络方面面临的挑战的理解有限.
- 管理护理计划对医生选择的歧视性做法不确定.
研究的目的:
- 调查医生合同拒绝或终止的发生率和预测因素.
- 评估这些合同变更对初级保健医生的管理护理参与的影响.
主要方法:
- 加利福尼亚州初级保健医生的横截面邮件调查.
- 分析与独立实践协会 (IPA) 或健康维护组织 (HMO) 的合同拒绝/终止情况.
主要成果:
- 22%的医生经历了合同拒绝/终止; 87%的医生至少有一个合同.
- 个人实践是拒绝/终止和缺乏合同的预测因素.
- 管理护理中的医生为更少的无保险和非白人患者提供服务.
结论:
- 拒绝/终止合同是常见的,但并不能阻止大多数医生参与管理护理.
- 选择性合同可能不会因医生特征而有系统的歧视.
- 对医生服务于服务不足的人群存在潜在的偏见.
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