PubMed · 10157731
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E Harris. Managed care accelerates.. https://pubmed.ncbi.nlm.nih.gov/10157731/
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OBJECTIVES: To compare different methods being used to determine eligibility for enhanced capitation registration payments, which were introduced in the UK in April 1998 with the intention of improving the numbers of children aged 0-5 years from deprived areas registering with General Dental Service practitioners. DESIGN: Comparative study of the enhanced capitation registration payment schemes; data from a longitudinal study of Scottish children used to compare patient and dentist postcodes. OUTCOME MEASURES: Published registration rates; levels of agreement between patient and dentist postcodes. RESULTS: Quarterly registration rates for 3-5-year-olds show little improvement as yet; Scottish figures for 0-2-year-olds indicate a more substantial increase which may have been influenced by other initiatives. In Scotland, the degree of agreement between the deprivation scores of patient's and their dentist's postcode was less good among patients from deprived areas than for the sample as a whole. CONCLUSIONS: More detailed breakdown, using the same criteria as for the enhanced payments, may eventually offer more definitive results. Patient postcodes enable better targeting than practice postcodes, but both may omit a substantial number from the target group if area measures of deprivation are used.
Just a few years after global capitation seemed like the wave of the future, it has crashed into reality: Most of the inefficiencies have been squeezed out of the U.S. healthcare system, and capitated rates are no longer covering costs. Some HMOs are returning to older payment methods, such as per diems.