Contractual Arrangements Between HMOs and Primary Care Physicians: Three-Tiered HMOs and Risk Pools
Contractual Arrangements Between HMOs and Primary Care Physicians: Three-Tiered HMOs and Risk Pools
复制标题
HMO 和初级保健医生之间的合同安排：三层 HMO 和风险池
作者：
A. Hillman;W. Welch;M. Pauly
对健康维护组织(HMO)和初级保健医生之间某些合同安排的担忧导致政策制定者考虑限制这些安排；已经通过了一项法律。然而，这些安排很复杂，其影响既不明显，也不被很好地理解。本文首先提出了一个概念性的方法来理解卫生保健组织和初级保健医生之间的关系，并讨论了它们如何影响财务风险和管理控制的场所。然后，它通过检查260个医疗保健组织的调查答复(占医疗保健组织总登记人数的50%以上)，加深了对两个关键维度(三级医疗保健组织和风险池)的理解。评估结果得出的结论是，三级医疗保健组织的初级保健医生不受医疗保健组织颁布的一些财务激励和合同安排的影响，使用风险池的原因可能更多地是由于同行群体效应或与其他激励措施的相互作用，而不是风险池对医生个人的直接财务影响。这些概念和观察结果对美国和其他地方的其他类型的医疗保健系统具有相关性。除非政策制定者了解这些安排的细节，否则他们可能会实施被误导的政策。
Concern about certain contractual arrangements between health maintenance organizations (HMOs) and primary care physicians has led policymakers to consider curbing these arrangements; one law has already been passed. However, these arrangements are complex and their impact is neither obvious nor well understood. This article first presents a conceptual approach to understanding the relationship between HMOs and primary care physicians and discusses how they influence the locus of financial risk and managerial control. It then refines understanding of two critical dimensions (three-tiered HMOs and risk pools) by examining survey responses of 260 HMOs (representing over 50% of total HMO enrollment.) Results of the evaluation led to the conclusion that primary care physicians in three-tiered HMOs are sheltered from some of the financial incentives and contractual arrangements enacted by the HMO and that the reason for using risk pools may be due more to peer group effects or interaction with other incentives, rather than the direct financial implications of the risk pool on individual physicians. These concepts and observations have relevance for other types of health care systems in this country and elsewhere. Policymakers risk enacting misguided policies unless they understand the details of these arrangements.