Assuntos
Sistemas Pré-Pagos de Saúde/economia , Planos de Incentivos Médicos/economia , Qualidade da Assistência à Saúde/economia , Connecticut , Comportamento do Consumidor , Sistemas Pré-Pagos de Saúde/normas , Acessibilidade aos Serviços de Saúde , Hospitalização/economia , Corpo Clínico/economia , Sistemas Multi-Institucionais/economia , Sistemas Multi-Institucionais/normas , New Jersey , Cidade de Nova Iorque , Philadelphia , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/normas , Salários e BenefíciosRESUMO
U.S. Healthcare (USHC) contracts for care with primary care physicians who are compensated through capitation (i.e., a fixed payment at specific intervals per member for all care provided, irrespective of the number of services). The amount of capitation is dependent upon their quality assessment rating and their ability to manage the cost of care effectively. In January of 1992 USHC implemented its current, third-generation incentive model and significantly altered its Quality Care Compensation System. The evolution of this model is presented to demonstrate that this third-generation Quality Care Compensation Model is a fair and effective means of measuring and valuing the delivery of health care to a population. It rewards physicians who expend the extra effort to manage both quality and cost. The experience of USHC continues to demonstrate that it is possible to develop and monitor incentive mechanisms in a systematic fashion with quality improvement as the outcome.
Assuntos
Sistemas Pré-Pagos de Saúde/economia , Sistemas Pré-Pagos de Saúde/normas , Médicos de Família/normas , Garantia da Qualidade dos Cuidados de Saúde/economia , Reembolso de Incentivo , Adulto , Capitação , Criança , Humanos , Pennsylvania , Médicos de Família/economia , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administraçãoRESUMO
The ultimate challenge in dealing with any type of risk incentive system is to be able to integrate the quality of care and the cost of care into an equitable system and to monitor the system and detect either barriers to care or the withholding of appropriate services. We believe it is possible to do this and have based our incentive model upon this premise. At U.S. Healthcare, we have been successful in developing some measures of quality in the ambulatory setting and have tied the measurements to our payment mechanism.
Assuntos
Planos de Incentivos Médicos , Qualidade da Assistência à Saúde/economia , Modelos Teóricos , Reembolso de Incentivo , Estatística como Assunto , Estados UnidosRESUMO
During investigation of splenomegaly in a boy with chronic renal failure and osteodystrophy, bone marrow aspirates resulted in "dry taps," whereas biopsied material provided evidence that the marrow had been replaced by fibrous tissue. In a study of six other children with chronic renal failure, similar changes were observed. These findings suggest that the anemia of chronic renal failure may in part be a result of myelofibrosis, and the resulting reduction of functional bone marrow may limit the tolerance to immunosuppressive agents in patients who undergo renal transplantation.