The future of managed care organization.
The future of managed care organization.
复制标题
管理式医疗组织的未来。
作者：
J. Robinson
本文分析了管理式医疗系统中的中心组织的转变：多产品、多市场的健康计划。它研究了纵向分解，从所有权到计划和提供者组织之间的合同联系的转变，以及横向整合-以前的赔偿承运人，蓝十字计划，健康维护组织（HMO）和专业网络的合并。卫生保健消费者对特定产品和网络特征的偏好和支付意愿差异很大，而提供者对采用特定组织和融资结构的意愿差异很大。这种异质性为健康计划创造了一个持久的角色，这些健康计划分散到多个网络，福利产品，分销渠道和地理区域。多样化现在正在推动健康计划成为全国性的、提供全方位服务的公司，而不是与特定供应商联系在一起、向特定消费者利基市场销售的地方性、单一产品组织。
This paper analyzes the transformation of the central organization in the managed care system: the multiproduct, multimarket health plan. It examines vertical disintegration, the shift from ownership to contractual linkages between plans and provider organizations, and horizontal integration--the consolidation of erstwhile indemnity carriers, Blue Cross plans, health maintenance organizations (HMOs), and specialty networks. Health care consumers differ widely in their preferences and willingness to pay for particular products and network characteristics, while providers differ widely in their willingness to adopt particular organization and financing structures. This heterogeneity creates an enduring role for health plans that are diversified into multiple networks, benefit products, distribution channels, and geographic regions. Diversification now is driving health plans toward being national, full-service corporations and away from being local, single-product organizations linked to particular providers and selling to particular consumer niches.