Policy Issues in Medical Computing. Health Care Economics and Medical Computing: Private Review—Running a Medical Care Foundation with a Microcomputer

摘要

The Physicians' Medical Care Foundation of Toledo, Ohio, runs an area-wide private review system inexpensively with a part-time manager and a microcomputer. Using Blue Cross claims, the Foundation identifies those physicians whose patterns of practice (adjusted for patient mix) indicate high use of hospital days, and employs confidential peer pressure and “data pressure” to bring about changes in physician behavior. The first five interventions, starting in December 1982, were in the areas of obstetrical delivery, uncomplicated inguinal hernia, chronic diseases of tonsils and adenoids, diabetes mellitus, and certain psychiatric conditions. Early results suggest that through June 1983 changes in physician practices accounted for use of 1,386 fewer hospital days for these categories of Blue Cross patients, for annualized savings in hospital charges estimated at more than $1.1 million.