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題名：美國健康維護組織的近來發展趨勢
書刊名：護理雜誌
作者：林恆慶 引用關係／陳楚杰 引用關係
作者(外文)：Lin, Herng-ching／Chen, Chiu-chieh
出版日期：2003
卷期：50:6
頁次：頁55-61
主題關鍵詞：健康維護組織；守門員制度；論人計酬制度；Health maintenance organization；Capitation；Gatekeeper
原始連結：連回原系統網址new window
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　　　　　促成健康維護組織在二十世紀末期蓬勃興盛的主因，即在於其抑制醫療費用上漲的能力，然而在進入二十一世紀後，健康維護組織是否能繼續有效控制醫療費用並被醫療服務提供者及被保險人所接受，實在值得我們觀察研究。因此，本文首先擬介紹近幾年健康維護組織的最新發展趨勢，進而提出對台灣健康照護體系改革的啟示，以提供衛生專業人員及衛生政策制定者之參考。健康維護組織的最新發展趨勢有(1)廢除守門員制度；(2)大幅提高被保險人自付額；(3)醫療服務提供者解除與健康維護組織的特約；(4)對醫療服務提供者的給付開始大量採用論量計酬制度；(5)法案不利健康維護組織；(6)健康維護組織的總投保人數開始下滑；(7)開始外包內部的資訊系統；(8)提高健康維護組織的保費；(9)營利為目的的健康維護組織數目大幅成長；(10)更重視預防醫學及(11)健康維護組織開始獲利等十一項最新發展趨勢。建議衛生主管相關單位重新思考論人計酬制度的可行性、提高被保險人部份負擔的費用、強化資訊系統的功能、將醫療給付與醫療品質相結合，以控制醫療費用及提高醫療品質，進而確保國民的健康。
　　　　　Cost containment is the major reason for the growth of health maintenance organizations (HMOs) at the end of the 20th century. However, at the turn of the 21st century, whether the HMOs can continue to control costs and to be accepted by providers remains unknown. The purposes of this article are to introduce the trends in HMOs' development and to propose recommendations applicable to health professionals in Taiwan. At the beginning of the 21st century, trends in HMOs' development include (1) discarding the gatekeeper system; (2) increases in the amounts of copayments and deductibles; (3) the end of the contracts between HMOs and providers; (4) the use of fee-for-service to replace capitation; (5) anti-HMO legislation; (6) reductions in the number of HMOss enrollment; (7) outsourcing of HMOs' information systems; (8) increases in the premiums of HMOs; (9) an increase in the number of for-profit HMOs; (10)emphasis on preventive medicine; and (11) HMOs' beginning to earn profits. The capitation and gatekeeper systems adopted by traditional HMOs have gradually been abandoned. HMOs are beginning to shift the responsibility for cost containment from providers to consumers. In addition, HMOs are committed to preventive medicine and the upgrading of their information systems. Although it is difficult to predict the trends in HMOs' development, the experience of the HMOs offers lessons for the health delivery system in Taiwan. It is recommended to reconsider the feasibility of capitation system, to shift the responsibility of cost containment from providers to consumers, to reinforce information systems, and to emphasize quality of medical care in Taiwan.
期刊論文
1.Arnold, C.(2000)。N. J. Bill would allow suits against HMOs。National Underwriter，104(42)，45。  new window
2.Arnst, C.、McNatt, R.(20000717)。Hospitals: Out of patience。Business Week，2000(Jul.)，8。  new window
3.Editorial Oomments(2000)。HMOs lose $186 million in 1999。Healthcare Financial Management，54(11)，21-22。  new window
4.Editorial Opinion(2002)。Report: HMO enrollment stabilizing, HMO Medicaid continues to grow。Health Care Strategic Management，20(9)，13-14。  new window
5.Ferris, T. G.、Chang, Y.、Blumenthal, D.、Pearson, S. D.(2001)。Leaving gatekeeping behind-effects of opening access to specialists for adults in a health maintenance organization。The New England Journal of Medicine，345(18)，1312-1317。  new window
6.Franczyl, A.(2001)。HMOs open campaign in bid to lure members。Business First，18(3)，4-5。  new window
7.Gabel, J.(1997)。Ten ways HMOs have changed during the 1990s。Health Affairs，16(3)，134-145。  new window
8.Galewitz, P.(20020919)。Consumer group says nation's HMOs improving service。Knight Ridder Tribune Business News，1。  new window
9.Galloro, V.(2000)。Drop in uninsured, drop in HMO ranks。Modern Healthcare，30(41)，2-3。  new window
10.Group Health Association of America(1988)。Unique approaches to case management。Group Health Association of America News，29(13)，7-11。  new window
11.Iversen, T.、Luras, H.(2000)。The effect of capitation on GPs’ referral decisions。Health Economics，9(3)，199-210。  new window
12.Jacob, J. A.(2001)。Big plans put HMOs back in the black。American Medical News，44(33)，27。  new window
13.Kao, A. C.、Green, D. C.、Zaslavsa, A. M.、Koplan, J. P.、Cleary, P. D.(1998)。The relationship between method of physician payment and patient trust。The Journal of American Medical Association，280(19)，1708-1714。  new window
14.Lohr, K. N.、Brook, R. H.、Kamberg, C. J.、Goldberg, G. A.、Leibowitz, A.、Keesey, J.、Reboussin, D.、Newhouse, J. P.(1986)。Use of medical care in the Rand Health Insurance Experiment. Diagnosis- and service-specific analyses in a randomized controlled trial。Medical Care，24(Suppl.9)，S1-S87。  new window
15.Manning, J.(20020704)。HMO Premiums to Rise by 17 Percent in 2003, Study says。Knight Ridder Tribune Business News，5。  new window
16.Manning, M.(2001)。HMO hikes a pain for all。St. Louis Business Journal，21(50)，1。  new window
17.Meska, A.(2001)。Profitability improves for HMOs。Advisor Today，96(9)，39-40。  new window
18.Morrisey, J.(1999)。HMO outsources technology services。Modern Healthcare，29(42)，43。  new window
19.Nash, K. S.(2000)。System mended, HMO outsources。Computerworld，34(46)，1-2。  new window
20.Olenchek, C.(2000)。Seniors face fallout from HMOs' retreat。Central Pennsylvania Business Journal，16(45)，3-6。  new window
21.Pauly, M. V.、Hillman, A. L.、Furukawa, M. F.、McCullough, J. S.(2001)。HMO behavior and stock market valuation: What does Wall Street reward and punish?。Journal of Health Care Finance，28(1)，7-15。  new window
22.Shauna, R.(2000)。Health Maintenance Organizations Part 2: do you get good care?。Diabetes Forecast，53(12)，78-80。  new window
23.Solnik, C.(2002)。Vytra's new HMO shuts the door on gatekeepers。Long Island Business News，49(6)，A4。  new window
24.Webb, M.(2001)。HMO exec salaries studied as rate rises。San Diego Business Journal，22(36)，1。  new window
25.簡聰健(19980100)。HMOs探討系列之二:如何落實管理式競爭之理念﹖。臺灣醫界，41(1)，53-56+61。  延伸查詢new window
26.魏中仁、鍾國彪、張睿詒、陳維昭、林文德、楊志良(19971200)。全民健保醫療照護採類似HMO制度之可行性探討(1)--接受程度之分析。醫院，30(6)，1-12。  延伸查詢new window
27.尤之毅(19990800)。我國管理式醫療機構設置之探討。醫院，32(4)，28-34。  延伸查詢new window
28.江東亮、胡德偉(20001000)。美國發展管理式照護的經驗與啟示。中華公共衛生雜誌，19(5)，340-355。new window  延伸查詢new window
29.李隆生(19981200)。全民健保改制--HMOs是答案嗎﹖。醫院，31(6)，33-39。  延伸查詢new window
圖書
1.American College of Healthcare Executives(1999)。Managed care essentials: A book of readings。Chicago, IL：Health administration Press。  new window
2.Kongstvedt, P. R.(2001)。Essentials of managed health care。Gaithersburg, ML：Aspen。  new window
3.Robbins, D. A.(1998)。Managed care on trial: Recapturing trust, integrity, and accountability in healthcare。New York：McGraw-Hill。  new window
4.Scott, R. W.、Reuf, M.、Mendel, P. J.、Caronna, C. A.(2000)。Institutional change and healthcare organizations。Chicago, IL：The University of Chicago。  new window
5.Shi, L.、Singh, D. A.(1998)。Delivering Health Care In America: A Systems Approach。Aspen。  new window
6.Baldor, R. A.(1998)。Managed care。Worcestor, MA：Blackwell science。  new window
其他
1.Eckelbecker, L.(200209)。HMOs to hike seniors' rates: copayments, premiums to rise。  new window
 
 
 
 
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