Journal Article10.2307/3349925
Paying for HMO care: issues and options in setting capitation rates.
TL;DR: The problem of how to establish payment rates for individuals becomes increasingly important because of increased total costs, windfall profits for some providers, and the loss of comprehensive coverage for high-risk individuals.
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Abstract: As the public and private sectors continue to promote use of capitated health care systems, the problem of how to establish payment rates for individuals becomes increasingly important. Inattention to pricing policies can lead to increased total costs, windfall profits for some providers, and the loss of comprehensive coverage for high-risk individuals. Capitation systems used by government and corporations are measured against social and economic ideals; the shortfall can be addressed by proposed new alternatives.
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Citations
Evaluation of the equity of age-sex adjusted primary care capitation payments in Ontario, Canada.
Lyn M. Sibley,Richard H. Glazier +1 more
TL;DR: The findings suggests that under the physician reimbursement system used in Family Health Networks in Ontario, physicians are under-compensated for the health care needs of low income patients and over-compensation for the needs of high income patients.
37
Pediatric carve outs: The use of disease-specific conditions as risk adjusters in capitated payment systems
TL;DR: Lists of disease-specific carve outs such as this one can be used by Medicaid plans and other insurers who are concerned about risk selection to identify conditions for separate reimbursement in capitated payment systems.
25
•Journal Article
A comparison of three methods for estimating the requirements for medical specialists: the case of otolaryngologists.
TL;DR: Three established methods of computing the national requirements for otolaryngologists in 1994 and 2010 were compared: managed care, demand-utilization, and adjusted needs assessment.
23
•Journal Article
Beneficiary selection, use, and charges in two Medicare capitation demonstrations.
TL;DR: Findings with regard to health status, service use, and charges are presented for Medicare beneficiaries who received care under Medicare risk contracts with two health maintenance organizations from 1980 through 1982 and for fee-for-service comparison groups.
•Journal Article
Modified capitation and treatment incentives for end stage renal disease.
TL;DR: A modified capitation payment method for the Medicare end stage renal disease (ESRD) program designed to support appropriate treatment choices and protect health plans from undue financial risk is developed.
14
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