Does managed care lead to better or worse quality of care? A survey of recent studies shows mixed results on managed care plan performance.
Does managed care lead to better or worse quality of care? A survey of recent studies shows mixed results on managed care plan performance.
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DOI：
10.1377/hlthaff.16.5.7
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发表时间：
1997-09-01
期刊：
影响因子：
9.7
通讯作者：
Luft, HS
中科院分区：
文献类型：
--
作者：
Miller, RH;Luft, HS
我们分析了最近发表的37项同行评议研究中关于管理型医疗计划(主要是健康维护组织，简称HMO)绩效的证据。来自15项研究的护理质量证据显示，与非HMO计划相比，HMO结果明显更好和更差的数量相等。然而，在几种情况下，患有慢性病的联邦医疗保险HMO参与者表现出较差的护理质量。比较医院和医生资源使用的证据没有明确的模式，而关于参与者满意度的证据因衡量标准和参与者类型而不同。尽管最近的研究提供了有用的发现，但很难从这些相对较少的研究中解释和概括，尽管所有高质量的数据都是在1992年开始的最新一轮成本削减之前收集的，但对医疗保健组织一致导致较差护理质量的担忧没有证据支持。医疗保健组织将提高整体质量的希望也得不到支持，部分原因是临床实践变化缓慢，缺乏风险调整的碳酸化率，以及质量衡量和报告不足。
We analyzed evidence on managed care plan (mostly health maintenance organization, or HMO) performance from thirty-seven recently published peer-reviewed studies. Quality-of-care evidence from fifteen studies showed an equal number of significantly better and worse HMO results, compared with non-HMO plans. However, in several instances, Medicare HMO enrollees with chronic conditions showed worse quality of care. Evidence comparing hospital and physician resource use showed no clear pattern, whereas evidence on enrollee satisfaction varied by measure and enrollee type. Although recent research provides useful findings, interpreting and generalizing from these relatively few studies is difficult, Fears that HMOs uniformly lead to worse quality of care are not supported by the evidence, although all quality data were collected prior to the recent round of cost cutting that started in 1992. Hopes that HMOs would improve overall quality also are not supported, in part because of slow clinical practice change, lack of risk-adjusted capitation rates, and inadequate quality measurement and reporting.