Health Care Delivery Systems and Primary Care Performance. Abstract, Executive211 Summary and Final Report

摘要

Health policy studies in the U.S. have long focused on the importance of211u001estrengthening primary care delivery in order to address the persistent concerns 211u001eof cost, quality, and access. Previous research demonstrates significant 211u001edifferences in primary care performance across difference models of health 211u001einsurance (plan-types). Further study was compelled by substantial changes in the 211u001eorganization and financing of care, including the emergence of new plans-types 211u001eand redistribution of populations among plan-types. This study used information 211u001eobtained from patients, physicians, health plan executives, and administrative 211u001esources to compare performance across 5 models of health insurance (managed 211u001eindemnity, point-of-service, IPA/network-model HMO, and staff-model HMO), to 211u001eidentify characteristics of providers and patients that are associated with 211u001eperformance differences, and to examine the relationship between primary care 211u001eperformance and outcomes of care. Primary care performance refers to performance 211u001eon each of 7 defining characteristics of primary care: accessibility, continuity, 211u001ecomprehensiveness, integration, clinical management, a 'whole-person' 211u001eorientation, and sustained clinician-patient partnership.