The growth of medical groups paid through capitation in California.
The growth of medical groups paid through capitation in California.
复制标题
加利福尼亚州按人头付费的医疗团体的增长。
DOI：
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发表时间：
1995
影响因子：
158.5
通讯作者：
L. Casalino
中科院分区：
文献类型：
--
作者：
J. Robinson;L. Casalino
背景
在加利福尼亚州，健康维护组织(HMO)与大型医疗集团签约是很常见的，这些集团通过按人头付费并负责管理全方位的医疗服务。
方法
我们研究了加利福尼亚州的六家大型医疗集团--布里斯托尔公园医疗集团、Friendly Hills Healthcare Network、医疗合作伙伴医疗集团、Mullikin医疗中心、帕洛阿尔托医疗基金会和圣何塞医疗集团--这些集团通过按人头付费，并且由于与管理型医疗组织签订了合同而不断增长。我们进行了采访，并获得了一些因素的数据，如患者登记、按人头计算和其他收入、登记者在医院停留的天数以及每位登记者去看医生的次数。
结果
在1990至1994年间，在六个医疗小组中，通过按人头计算支付医疗费用的HMO登记人数增加了91%，从398,359人增加到759,474人。1994年，非医疗保险患者每1000名HMO参与者的平均住院天数从120天到149天不等，医疗保险患者的住院天数从643天到936天不等。相比之下，1993年，没有得到联邦医疗保险覆盖的每1000名HMO参与者的平均住院天数，加利福尼亚州为232天，美国为297天；而在联邦医疗保险覆盖的HMO参与者中，这一数字为加州的1337天，美国的1698天。1994年，未纳入医疗保险的六组医疗保健组织患者的年平均就诊次数为3.1至3.9次；医疗保险患者的年平均就诊次数为7.2至9.3次；这些比率略低于全州和全国的比率。其中四家集团已将其资产(如设施、用品、设备和病历)出售给外部投资者；医生仍受雇于医生所有的专业公司。
结论
按人头支付的医疗集团为管理型医疗系统中医生的地位提供了一种模式，不同于工作人员模式HMO提供的员工身份，以及HMO直接与医生个人谈判提供的分包商身份。尽管增长迅速，但加州的这类医疗集团面临着巨大的挑战，比如获得维持快速增长所需的金融资产。
BACKGROUND
In California, it is common for health maintenance organizations (HMOs) to contract with large medical groups that are paid through capitation and are responsible for managing a full spectrum of medical services.
METHODS
We studied six large medical groups in California--Bristol Park Medical, Friendly Hills HealthCare Network, HealthCare Partners Medical Group, Mullikin Medical Centers, Palo Alto Medical Foundation, and San Jose Medical Group--that are paid through capitation and that are growing as a result of contracts with managed-care organizations. We conducted interviews and obtained data on factors such as patient enrollment, capitation and other revenue, numbers of days spent by enrollees in the hospital, and numbers of visits to physicians per enrollee.
RESULTS
Between 1990 and 1994, the number of HMO enrollees whose care was paid for through capitation in the six medical groups increased by 91 percent, from 398,359 to 759,474. In 1994, the mean number of hospital days per 1000 HMO enrollees ranged from 120 to 149 for non-Medicare patients and from 643 to 936 days for Medicare patients. By comparison, in 1993 the mean numbers of hospital days per 1000 HMO enrollees not covered by Medicare were 232 for California and 297 for the United States; for HMO enrollees covered by Medicare, the numbers were 1337 for California and 1698 for the United States. In 1994, the average annual number of visits to physicians for HMO patients in the six groups not covered by Medicare ranged from 3.1 to 3.9; for Medicare patients, it ranged from 7.2 to 9.3; these rates were slightly lower than statewide and national rates. Four of the groups have sold their assets (such as facilities, supplies, equipment, and patients' charts) to outside investors; the physicians remain employed by physician-owned professional corporations.
CONCLUSIONS
Medical groups paid through capitation offer a model for the status of physicians in managed-care systems that differs from the employee status offered by staff-model HMOs and the subcontractor status offered by HMOs that negotiate directly with individual physicians. Despite their growth, such medical groups in California face substantial challenges, such as obtaining the financial assets necessary to sustain rapid growth.