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Impact of managed care on physicians' decisions to manipulate reimbursement rules: an explanatory model

机译：管理式护理对医师决定操作报销规则的影响：一种解释模型

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摘要

Objective:To develop and test an explanatorymodel of the impact ofmanaged care on physicians’decisionsntomanipulate reimbursement rules for patients.nMethods: A self-administered mailed questionnaire of a national random sample of 1124 practicing physiciansnin the USA. Structural equation modelling was used. The main outcome measure assessed whethernor not physicians hadmanipulated reimbursement rules (such as exaggerated the severity of patients conditions,nchanged billing diagnoses, or reported signs or symptoms that the patients did not have) to help patientsnsecure coverage for needed treatment or services.nResults:The response rate was 64%(n紏720). Physicians’decisions tomanipulate reimbursement rules fornpatients are directly driven not only by ethical beliefs about gaming the system but also by requests fromnpatients, the perception of insu⁄cient time to deliver care, and the proportion of Medicaid patients. Covertnadvocacy is also the indirect result of utilization review hassles, primary care specialty, and practice environment.nConclusions: Managed care is not just a set of rules that physicians choose to follow or disobey, but annenvironment of competing pressures from patients, purchasers, and high workload. Reimbursementnmanipulation is a response to that environment, rather than simply a re￡ection of individual physicians’nvalues.
机译：目的：建立并测试一种解释性模型，说明管理式护理对医师决定患者的医疗补偿规则的影响。n方法：一份自行邮寄的问卷，其中包含美国1124名执业医师的全国随机样本。使用结构方程模型。主要结果指标评估了医生是否没有制定报销规则（例如夸大患者病情的严重性，更改账单诊断或报告患者没有的体征或症状）以帮助患者确保获得所需治疗或服务的保障。回应率为64％（n紏720）。医师为患者制定报销规则的决定不仅直接取决于有关博彩系统的道德观念，而且还受到患者的要求，对提供护理的时间不足以及医疗补助患者比例的直接驱动。隐瞒也是使用审查麻烦，初级保健专业和实践环境的间接结果。n结论：管理式保健不仅是医生选择遵循或不遵守的一套规则，而且还避免了来自患者，购买者和上级医生的竞争压力工作量。报销操作是对这种环境的一种反应，而不是简单地反映各个医师的价值观。

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  • 来源
    《Journal of Health Services Research_Policy》 |2007年第3期|p.147-152|共6页
  • 作者

    Jonathan VanGeest Saul Weiner Timothy Johnson and Deborah Cummins;

  • 作者单位

    WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA;

    1Department of Medicine and Departmentof Pediatrics, University of Illinois at Chicago, and the Veterans Affairs Midwest Center for Health Services and Policy Research, Chicago, IL,USA;

    2College of Urban Planning and Public Affairs, University of Illinois at Chicago, Chicago, IL, USA;

    3Department of Medical Education,University of Illinois at Chicago, Chicago, IL, USA;

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  • 正文语种 eng
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  • 关键词

    physicians;

    机译：医师;

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