Cost containment through risk-sharing by primary-care physicians. 1979

S Moore

A new type of independent practice association has been organized to encourage primary-care physicians in private practice to become coordinators and financial managers for all medical care. Each patient chooses one internist, family or general physician or pediatrician and must be referred by that physician for all specialized care. The primary-care physician authorizes payment from his own account for all care provided to his patients. He shares any dificit or surplus remaining at the end of the year. After four years of operation, United Healthcare has 610 primary-care physicians treating 23,000 patients. Total hospital use during 1978 and 293 bed-days per 1000 patients, as compared with 479 for Blue Cross. The hospital-admission rate per 1000 was 88, as compared with 101 for Blue Cross. Average lengths of stay were 3.3 and 4.7 dyas, respectively. This plan represents another means to control costs in the private medical marketplace.

UI MeSH Term Description Entries
D007348 Insurance, Health Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading. Group Health Insurance,Health Insurance,Health Insurance, Voluntary,Health Insurance, Group,Health Insurances,Insurance, Group Health,Insurance, Voluntary Health,Insurances, Health,Voluntary Health Insurance
D007349 Insurance, Health, Reimbursement Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988) Health Insurance Reimbursement,Reimbursement, Health Insurance,Third-Party Payments,Third-Party Payers,Health Insurance Reimbursements,Insurance Reimbursement, Health,Insurance Reimbursements, Health,Payer, Third-Party,Payers, Third-Party,Payment, Third-Party,Payments, Third-Party,Reimbursements, Health Insurance,Third Party Payers,Third Party Payments,Third-Party Payer,Third-Party Payment
D007350 Insurance, Hospitalization Health insurance providing benefits to cover or partly cover hospital expenses. Group Hospitalization,Hospitalization Insurance,Hospitalization, Group
D009042 Motivation Those factors which cause an organism to behave or act in either a goal-seeking or satisfying manner. They may be influenced by physiological drives or by external stimuli. Incentives,Disincentives,Expectations,Disincentive,Expectation,Incentive,Motivations
D011320 Primary Health Care Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192) Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D011331 Private Practice Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice. Solo Practice,Practice, Private,Practice, Solo,Practices, Private,Practices, Solo,Private Practices,Solo Practices
D012017 Referral and Consultation The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide. Consultation,Gatekeepers, Health Service,Hospital Referral,Second Opinion,Consultation and Referral,Health Service Gatekeepers,Hospital Referrals,Referral,Referral, Hospital,Referrals, Hospital,Consultations,Gatekeeper, Health Service,Health Service Gatekeeper,Opinion, Second,Opinions, Second,Referrals,Second Opinions
D003258 Consumer Behavior Behavior associated with the procurement of goods, services, or experiences. Consumer Preference,Consumer Satisfaction,Behavior, Consumer,Behaviors, Consumer,Consumer Behaviors,Consumer Preferences,Preference, Consumer,Preferences, Consumer,Satisfaction, Consumer
D003363 Cost Control The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed) Cost Containment,Containment, Cost,Containments, Cost,Control, Cost,Controls, Cost,Cost Containments,Cost Controls
D006279 Health Maintenance Organizations Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988) Group Health Organizations, Prepaid,HMO,Prepaid Group Health Organizations,Health Maintenance Organization,Organizations, Health Maintenance,Organization, Health Maintenance

Related Publications

S Moore
December 1979, The New England journal of medicine,
S Moore
October 1979, The New England journal of medicine,
S Moore
October 1979, The New England journal of medicine,
S Moore
October 1979, The New England journal of medicine,
S Moore
January 1975, Hospitals,
S Moore
April 1984, Annals of internal medicine,
S Moore
April 1979, Review - Federation of American Hospitals,
S Moore
January 1995, Leadership in health services = Leadership dans les services de sante,
S Moore
September 1977, The New England journal of medicine,
S Moore
November 2003, The virtual mentor : VM,
Copied contents to your clipboard!