HEALTH CARE MARKETS AND VULNERABLE POPULATIONS

拟议的方案项目，题为“不断变化的医疗保健市场对弱势群体及其提供者的影响”，包括一系列相互关联的研究项目，将解决有关医疗保健市场结构的影响和管理式医疗的增长对各种弱势群体在美国的问题。该计划项目下的研究计划旨在为实现以下长期目标做出贡献：* 增加对医疗保健市场变化和趋势的了解，以及它们如何影响弱势群体及其提供者。* 提高对医疗保健市场结构如何影响获得医疗保险的理解;医疗保健的获得、利用和质量;以及弱势群体成员的经济和临床结果。该计划项目将包括五个组成项目，以及一个管理核心和一个综合核心中的数据、测量。每个项目和核心都将有助于实现计划项目的目标和主题，具体如下：项目1将评估医疗保健市场结构对医院提供的护理质量的影响，重点是对安全网和安全网内医院的潜在差异影响。项目2将评估卫生保健市场结构对安全网和非安全网医院在参与医院系统和管理式保健网络、财务业绩、提供服务和提供慈善护理方面的影响。项目3将审查市场结构对两个弱势群体获得雇主赞助的健康保险的影响：低工资企业的工人和在农村地区就业的工人。项目4将确定医疗保险管理式护理市场的结构如何影响经济和临床结果，包括保险选择、健康状况和慢性病老年人的自付费用。项目5将检查医疗保健的影响数据，措施和综合核心将作为该计划项目的智力中心，并将提供五个组成项目的概念和方法整合的主要场所。此外，该核心将创建一个关于医疗保健市场结构和安全网的上下文、市场层面数据库，并将编制报告和手稿，总结和综合该计划项目的调查结果。

The proposed Program Project, entitled "Impact of Changing Health Care Markets on Vulnerable Populations and Their Providers," consists of a series of interrelated research projects that will address questions regarding the effect of health care market structure an the growth of managed care on a variety of vulnerable populations in the United States. The research plan under the program project is intended to contribute toward the fulfillment of the following long range goals: * Increase understanding of the changes and trends in health care markets and how they influence vulnerable populations and their providers. * Increase understanding of how health care market structure affects access to health insurance; access, utilization and quality of medial care; and economic and clinical outcomes form members of vulnerable populations. The Program Project will include five component projects, as well as an Administrative Core and a Data, Measures, in Synthesis Core. Each project and core will contribute to the goals and theme of the Program Project, as follows: Project 1 will assess the effects of health care market structure on the quality of care provided by hospitals, focusing on potential differential effects for safety net and on-safety net hospitals. Project 2 will assess effects of health care market structure on safety net and non-safety net hospitals with regard to participation in hospital systems and managed care networks, financial performance, service offerings, and provision of charity care. Project 3 will examine the effects of market structure on access to employer-sponsored health insurance for two vulnerable populations: workers in low wage businesses and the workers employed in rural areas. Project 4 will determine how the structure of the Medicare managed care market affects economic and clinical outcomes, including insurance choice, health status, and out-of- pocket expenses for chronically ill elderly persons. Project 5 will examine the effects of health care Data, Measures, and Synthesis Core will serve as the intellectual center for the program project,, and will provide the main locus for conceptual and methodological integration of the five component projects. In addition, the Core will create a library of contextual, market-level data on health care market structure and the safety net, and will produce reports and manuscripts that summarize and synthesize the findings of the Program Project.