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首页> 外文期刊>Journal of general internal medicine >Patient protection and risk selection: do primary care physicians encourage their patients to join or avoid capitated health plans according to the patient's health status?
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Patient protection and risk selection: do primary care physicians encourage their patients to join or avoid capitated health plans according to the patient's health status?

机译：患者保护和风险选择：基层医疗医生是否会根据患者的健康状况鼓励患者加入或避免放弃有针对性的健康计划？

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BACKGROUND: Individual physicians who are paid prospectively, as in capitated health plans, might tend to encourage patients to avoid or to join these plans according to the patient's health status. Though insurance risk selection has been well documented among organizations paid on a prospective basis, such physician-level risk selection has not been studied. OBJECTIVE: To assess physician reports of risk selection in capitated health plans and explore potentially related factors. DESIGN AND PARTICIPANTS: National mailed survey of primary care physicians in 1997-1998, oversampling physicians in areas with more capitated health plans. RESULTS: The response rate was 63% (787 of 1,252 eligible recipients). Overall, 44% of physicians reported encouraging patients either to join or to avoid capitated health plans according to the patients' health status: 40% encouraged more complex and ill patients to avoid capitated plans and 23% encouraged healthier patients to join capitated plans. In multivariable models, physicians with negative perceptions of capitated plan quality, with more negative experiences in capitated plans, and those who knew at each patient encounter how they were being compensated had higher odds of encouraging sicker patients to avoid capitated plans (odds ratios, 2.0, 2.2, and 2.0; all confidence intervals >1). CONCLUSIONS: Many primary care physicians report encouraging patients to join or avoid capitated plans according to the patient's health status. Although these physicians' recommendations might be associated primarily with concerns about quality, they can have the effect of insulating certain health plans from covering sicker and more expensive patients.
机译：背景：按预期收费的个别医生（如首屈一指的健康计划）可能会倾向于鼓励患者根据患者的健康状况避免或加入这些计划。尽管在按预期付费的组织中，保险风险选择已得到充分证明，但尚未研究这种医生级别的风险选择。目的：评估有针对性的健康计划中医生关于风险选择的报告，并探讨潜在的相关因素。设计和参与者：1997-1998年全国邮寄的初级保健医生调查，在头号健康计划较多的地区对医生进行了过多抽样调查。结果：答复率为63％（在1,252名合格接受者中，有787名）。总体而言，有44％的医生报告根据患者的健康状况鼓励患者加入或避免放弃有针对性的健康计划：40％鼓励较复杂和患病的患者避免接受有屈服的计划，而23％鼓励更健康的患者加入有屈服的计划。在多变量模型中，对人头计划质量有负面认识的医生，在人头计划中具有更多的负面经验，并且知道每位患者如何获得补偿的医生更有可能鼓励病态的患者避免人头计划（赔率，2.0） ，2.2和2.0;所有置信区间> 1）。结论：许多初级保健医生报告根据患者的健康状况鼓励患者加入或避免放弃计划。尽管这些医生的建议可能主要与对质量的担忧有关，但它们可以起到使某些健康计划无法覆盖病情和费用更高的患者的作用。

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