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Workers' compensation in the United States and the role of the primary care physician

PRIMARY CARE 2000年第4期27卷 831-+页

作者： Pye, H Orris, P Cook Cty Hosp Div Occupat Med Chicago IL 60612 USA Univ Illinois Sch Publ Hlth Great Lakes Ctr Occupat & Environm Safety & Hlth Chicago IL USA

The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single public fund, the single private fund, and an open market. States range as well in the amount of choice available to the injured workers in their selection of health care providers. In each state though, the physician plays an integral role in ensuring that the injured worker obtains adequate medical care in a prompt and efficient manner. The physician's function is either as treating physician, or as one who provides an independent medical evaluation for either the employee's lawyer, the employer, the insurer or their counsel or the state. Many obvious improvements in the system have not been made because political agreement on the state level is often lacking.

关键词：病例管理/组织和管理合格鉴定司法鉴定家庭医学/组织和管理筹资政府/组织和管理卫生服务使用研究密执安模型组织管理职业医学/组织和管理医师的作用政治初级卫生保健/组织和管理私营部门/组织和管理美国华盛顿工人补偿金/组织和管理人类

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WHAT DO PUBLIC-HEALTH SERVICE AGENCIES DO WITH GRANT PROPOSALS

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AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 1977年第4期41卷 379-380页

作者： WILLETTE, RE NATL INST DRUG ABUSE ROCKVILLEMD 20857

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WHAT DOES A STUDY SECTION LOOK FOR IN EVALUATING A GRANT PROPOSAL

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AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 1977年第4期41卷 381-382页

作者： BUCKLEY, JP UNIV HOUSTON COLL PHARMDEPT PHARMACOLHOUSTONTX 77004

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The Organization of Community Health Programs: A prospective view from Cambridge

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HARVARD REVIEW OF PSYCHIATRY 1999年第4期7卷 216-221页

作者： Dorwart, RA Harvard Univ Sch Med Dept Psychiat Boston MA USA Harvard Univ Sch Med Dept Social Med Boston MA USA Cambridge Hlth Alliance Dept Psychiat Cambridge MA USA

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关键词：社区卫生服务/组织和管理社区精神卫生服务/组织和管理筹资政府/组织和管理医院社区/组织和管理分保集团/组织和管理马萨诸塞免费医疗人类

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On writing federal grant applications

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Journal of Mental Health Administration 1974年第2期3卷 17-30页

作者： Masterman, Louis E.

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Risk adjustment and the fear of markets: The case of Belgium

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Health Care Management Science 2000年第2期3卷 121-130页

作者： Schokkaert, Erik Van De Voorde, Carine Center for Economic Studies KU Leuven Leuven Belgium

In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming. © Baltzer Science Publishers BV.

关键词：比利时按人收费/组织和管理效率组织筹资政府/组织和管理预测卫生经费支出/统计学和数值数据保险选择偏倚管理医疗规划/组织和管理卫生服务使用研究/组织和管理国家卫生规划/组织和管理回归分析风险调节/组织和管理成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Capitation funding in Australia: Imperatives and impediments

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Health Care Management Science 2000年第2期3.0卷 77-88页

作者： Peacock, Stuart Segal, Leonie Health Economics Unit Centre for Health Program Evaluation Monash University West Heidelberg Vic. 3081 PO Box 477 Australia

Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they provide strong financial incentives for actors in the system to achieve policy goals. Underpinning funding mechanisms is a set of key economic principles, or objectives, that should guide their design and use: efficiency, equity, and accountability. The Australian health system has historically performed relatively poorly in relation to these objectives, with evidence of inefficiencies, inequities, and poor accountability in many areas of health services. The primary cause of these shortcomings may lie in the complex set of funding and delivery arrangements at the State and Federal levels of government. Potentially significant improvements in the performance of the health system would be available from the integration of the funding and delivery of services within a single tier of government, coupled with the development of a national weighted capitation approach to funding. To develop a national capitation funding model a number of unique factors require consideration, including the current fragmentation of services, the role of the private sector, the needs of indigenous populations, and the effects of rurality. The data available to develop a capitation model is of a level of detail and quality not readily found elsewhere. If policy statements promoting efficiency, accountability, and particularly equity are to be actively pursued, a national capitation model based on robust methods should become a cornerstone of Australian health system reform. © Baltzer Science Publishers BV.

关键词：澳大利亚按人收费/组织和管理卫生保健提供联合/组织和管理效率组织筹资政府/组织和管理卫生保健改革/组织和管理卫生服务易得程度/标准管理医疗规划/组织和管理模型组织管理国家卫生规划/组织和管理需求估价/组织和管理全面质量管理/组织和管理人类

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