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At least 397 records · Page 22Linked to original sources
PubMed1986

Capitation in California--an analysis of at-risk financing of Medicaid services.

Recent legislative changes have fostered the growth of a highly competitive health care market in California. In addition to selective hospital contracting for Medicaid (Medi-Cal) services, the California Medical Assistance Commission is attempting to initiate pilot projects to capitate Medi-Cal beneficiaries in selected geographic areas throughout the state. Selective contracting with county capitated organized health systems is also underway in Santa Barbara County, with plans for other counties on the drawing boards. This paper describes these capitated programs as well as addressing problems that may arise in this transition from a fee-for-service to a capitated Medi-Cal system. Specifically considered are issues related to underutilization, quality of care, implementation, eligibility and effects on existing patterns of care.

California↗
PubMed1983

State rate review and the relationship between capital expenditures and operating costs.

It is commonly assumed that an increase in capital expenditures leads to increased operating costs and a subsequent increase in rates, and thus that state rate review systems must incorporate certificate-of-need type controls over capital expenditures. The results of this study indicate that in those states with comprehensive rate review systems, increased capital expenditures may not lead to higher operating costs and rates; rather, increased wage rates are reflected in higher operating costs and rates. This pass-through of wages, and not capital costs, may have important policy implications.

Capital Expenditures↗
PubMed1984

On the research status of risk-adjusted capitation rates.

Capitation as an alternative to traditional charge and cost reimbursement has been a serious policy issue since at least 1970, and is currently one of the most seriously debated and far-reaching health issues before Congress. Nonetheless, the research effort on risk-adjusted per capita payment has been meager. In this overview, the author points out the pitfalls of prior utilization as a basis for capitation rates. He suggests instead that a capitation risk adjustment system be developed that eliminates cost variation resulting from patient risk but not that resulting from provider inefficiency, and that risk values across groups be normalized to prevent "risk group creep" and to ensure budget neutrality. He concludes that because obstacles were overcome in developing the current per admission DRG system for Medicare, the same can be done for a capitation system, and makes specific suggestions for doing so.

Actuarial Analysis↗
PubMed1983

Valuation: its impact on accounting measures of income and return on capital.

In the accounting model a return of capital can be guaranteed only in an unrealistic set of circumstances. Most organizations operate at an accounting breakeven, which guarantees bankruptcy because it results in a consumption of capital rather than a simple return of capital. Implicit in the pricing decision of many hospitals and their third party payers is the recovery of capital cost that would generate an accounting breakeven.

Accounting↗
PubMed1997

A framework for the management of intellectual capital in the health care industry.

This article proposes a new theoretical model for the effective management of intellectual capital in the health care industry. The evolution of knowledge-based resources as a value-adding characteristic of service industries coupled with mounting environmental pressures on health care necessitates the extension of current models of intellectual capital. Our theoretical model contains an expanded context linking its development to organizational learning theory and extends current theory by proposing a six-term archetype of organizational functioning built on flows of information. Further, our proposal offers a hierarchical dimension to intellectual capital and a method of scientific visualization for the measurement of intellectual capital. In conclusion, we offer some practical suggestions for future development, both for researchers and managers.

Capital Financing↗
PubMed1998

Growth through capitation and physician practice management.

Capitation achieves a competitive edge, yet many subacute care providers have not aggressively pursued this strategy. To take steps toward capitation, the following points need to be addressed: (1) determine what type of capitation to pursue; (2) establish the proper infrastructure to support capitated services; (3) implement a case management system; and (4) practice total quality management.

Capitation Fee↗
PubMed1998

Capitation is changing and expanding.

Capitated payment arrangements are changing and expanding. The private sector is paying growing attention to capitating dental care and paying capitation rates for specialty services. The federal government plans to experiment with global purchasing and competitive bidding to establish capitation rates for Medicare beneficiaries.

Capitation Fee↗
PubMed2003

[Scapho-capitate fracture syndrome of both hands--first description of a bilateral occurrence of a rare carpal injury].

The scapho-capitate fracture syndrome is a rare but severe injury of the carpus. It is characterized by a rotation of the proximal fragment of the capitate bone of 90 or 180 degrees and a fracture of the navicular bone in the intermediate third. This injury is caused by a fall on the outstretched and dorsiflected hand. The scapho-capitate fracture syndrome was firstly described in 1956 by Fenton. There are 31 cases described in literature but none of these involves both hands. Here we describe the first case of scapho-capitate fracture syndrome in both hands, in a 21 year old woman who jumped out of a window with suicidal intentions. She was treated operatively by Herbert-screws and K-wires.

Adult↗
PubMed2003

Children's mental health service use, neighbourhood socioeconomic deprivation, and social capital.

BACKGROUND: There is accumulating evidence that the shared social environment at the neighbourhood level exerts significant effects on health over and above individual level variables. The aim of this study was to assess the interactive influence of neighbourhood measures of socioeconomic deprivation and social capital (i. e. informal social control, social cohesion and trust) on children's mental health service use, independent of individual level confounders. METHODS: Two different data sources were used: 1) individual socioeconomic measures, derived from a case-control study in which case/control status indicated mental health service use or not, and 2) neighbourhood measures of socioeconomic deprivation and social capital. The data were subjected to multilevel logistic regression analysis. RESULTS: Children living in more deprived neighbourhoods run a higher risk of coming into contact with mental health care services. The social capital variables (informal social control and social cohesion and trust) did not exert main effects, but strong trust and social cohesion between citizens in the neighbourhood mitigated the risk-increasing effect of socioeconomic deprivation on children's mental health service use. CONCLUSIONS: The deleterious effects of socioeconomic deprivation on mental health service use in children are sensitive to the context of cohesion and trust in neighbourhoods. Effects of deprivation on children's mental health cannot be interpreted without taking into account the context of social capital.

Catchment Area, Health↗
PubMedDate not supplied

The effect of immigrants on natives' incomes through the use of capital.

"This paper deals with questions about the effects of immigrants on three types of capital: the private capital immigrants work with, the public (government) capital that immigrant workers use, and the public capital used for services by immigrants." The geographic focus is on the United States. The authors conclude that although the average cost to natives in 1975 dollars to provide services for immigrants is 4,172 dollars, this amount "is considerably smaller than the benefits of immigrants to natives through their relatively low use of welfare services and their relatively high contribution of taxes." Comments by Jacob Mincer (pp. 95-7) are included.

Americas↗
PubMed2003

Wage rentals for reproducible human capital: evidence from Ghana and the Ivory Coast.

Education, child nutrition, adult health/nutrition, and labor mobility are critical factors in achieving recent sustained growth in factor productivity. To compare the contribution of these four human capital inputs, an expanded specification of the wage function is estimated from household (LSMS) surveys of the Ivory Coast and Ghana. Specification tests assess whether the human capital inputs are exogenous, and instrumental variable techniques are used to estimate the wage function. Smaller panels from the Ivory Coast imply the magnitude of measurement error in the human capital inputs and provide more efficient instruments to estimate the wage equation. The conclusion emerges that weight-for-height and height are endogenous, particularly prone to measurement error, and heterogeneous in their effects on wages. Overall returns to these four forms of human capital are similar within each country for men and women, but education and migration returns are higher in the more rapidly growing Ivory Coast, and the wage effects of child nutrition proxied by height are greater in poorer, more malnourished Ghana.

Adolescent↗
PubMed2006

Linking social capital and self-rated health: a multilevel analysis of 11,175 men and women in Sweden.

This multilevel study included 11,175 participants interviewed 2000-2002 in Sweden. The association between neighbourhood linking social capital (voting in national elections) and self-rated health was analysed. Individuals living in neighbourhoods with the lowest levels of linking social capital exhibited a significantly higher risk of poor health than individuals living in neighbourhoods with the highest levels of linking social capital, after adjustment for individual characteristics, including individual voting. The neighbourhood variance indicated significant differences in self-rated health between neighbourhoods. Both individuals and neighbourhoods need to be targeted in order to enhance people's health in neighbourhoods with low linking social capital.

Adult↗
PubMed2004

Capitate-based kinematics of the midcarpal joint during wrist radioulnar deviation: an in vivo three-dimensional motion analysis.

PURPOSE: The purpose of this study was to obtain qualitative and quantitative information regarding in vivo 3-dimensional (3D) kinematics of the midcarpal joint during wrist radioulnar deviation (RUD). METHODS: We studied the in vivo kinematics of the midcarpal joint during wrist RUD in the right wrists of 10 volunteers by using a technology without radioactive exposure. The magnetic resonance images were acquired during RUD. The capitate was registered with the scaphoid, the lunate, and the triquetrum by using a volume registration technique. Animations of the relative motions of the midcarpal joint were created and accurate estimates of the relative orientations of the bones and axes of rotation (AORs) of each motion were obtained. RESULTS: The scaphoid, lunate, and triquetrum motions relative to the capitate during RUD were found to be similar, describing a rotational motion around the axis obliquely penetrating the head of the capitate in almost a radial extension/ulnoflexion plane of motion of the wrist. The AORs of the scaphoid, the lunate, and the triquetrum were located closely in space. In the axial plane the AORs of the scaphoid, lunate, and triquetrum formed a radially and palmarly opening angle of 43 degrees +/- 7 degrees, 41 degrees +/- 11 degrees, and 42 degrees +/- 14 degrees with the wrist flexion/extension axis, respectively. CONCLUSIONS: This study reports the in vivo 3D measurements of midcarpal motion relative to the capitate. Isolated midcarpal motion during RUD could be approximated to be a rotation in a plane of a radiodorsal/ulnopalmar rotation of the wrist, which may coincide with a motion plane of one of the most essential human wrist motions, known as the dart-throwing motion.

Adult↗
PubMed2004

Postsurgical rehabilitative management of avascular necrosis in the capitate.

OBJECTIVE: To discuss a case of avascular necrosis of the capitate and the follow-up postsurgical rehabilitation. CLINICAL FEATURES: A 41-year-old woman had severe left wrist pain. A short course of passive therapy was administered with no significant change. She was referred for additional diagnostic testing, including magnetic resonance imaging, which assisted in diagnosing the patient with avascular necrosis of the capitate. After undergoing surgical intervention, she was cleared to start an active rehabilitation program. She had significant loss of muscle strength and muscle atrophy and diminished active range of motion in the wrist and forearm. INTERACTION AND OUTCOME: The patient underwent surgical intervention consisting of an arthroplasty to the capitate. The follow-up rehabilitation techniques included the use of active and passive stretching, therapeutic putty, and light dumbbells. The patient was seen a total of 21 times during a 9-week time period. Outcome assessments were given intermittently during care to monitor progress. At the end of the program, she reported full function of the wrist with minimal to no pain. A 6-month follow-up showed improvements that were maintained with little pain. CONCLUSION: Avascular necrosis of the capitate is relatively rare. Advanced imaging should be used for diagnostic purposes. Surgical intervention may be warranted; however, it is recommended a postsurgical rehabilitative procedure be implemented.

Adult↗
PubMed2004

The European health divide: a matter of financial or social capital?

The 'European east--west health divide' has been documented both for mortality and for self-rated health. The reason for this divide, however, remains to be explained. The aim of this study is, firstly, to investigate whether in 1995-97 differences in self-rated health persisted between countries in central and eastern Europe, the former Soviet Union, and western Europe. A further aim is to try to explain these differences with reference to people's financial status and social capital. This study found substantial differences in self-rated health between countries in western Europe, in central and eastern Europe, and in the former Soviet Union (where self-rated health seems to be poorest in general). There were also substantial differences between areas in terms of economic and social capital, with western Europe doing better in all the analysed circumstances. In economic terms people in the former Soviet Union seemed to be more dissatisfied than those living in central and eastern Europe. When one looks at differences in social capital between the two post-communist areas the picture is more mixed. Economic satisfaction was demonstrated to have a strong and significant effect on people's self-rated health, with a higher satisfaction reducing the odds of 'poor' health. When this factor was controlled for the area, differences in self-rated health were reduced dramatically, for both men and women. Organisational activity (men only), trust in people, and confidence in the legal system also reduced the odds of 'less than good health', but were not as important in explaining the health differences between areas. One can conclude that economic factors as well as some aspects of social capital play a role for area differences in self-rated health. Of these it would appear that economic factors are the more important.

Adult↗
PubMed2001

A one-year experience with a capitated health care plan for infertility.

OBJECTIVE: To report on a one-year experience participating in a capitated healthcare plan for infertility. DESIGN: Prospective study. SETTING: University population. PATIENT(S): Reproductive-age women 15 to 50 years. INTERVENTION(S): The first-generation Lewin infertility algorithm and CATHI software were used to negotiate infertility services under a capitated arrangement for $0.50 per member per month. The following reports our experience for the fiscal year 1997. MAIN OUTCOME MEASURE(S): Infertility services rendered, pregnancy rate, cost of services, collection rates. RESULT(S): Five thousand forty-six women representing 39,689 member months generated 39 new and 198 return visits. Thirty-two percent of the patients required three visits or less; six patients generated 22% of the visits. Fifty-one percent listed infertility as one of their chief complaints; 31% had mixed diagnoses. Eight (7.6%) patients required surgery, 11 (10.5%) patients underwent either IVF or GIFT cycles. Total charges submitted were $176,636; the amount assigned to specialty care was $135,277, and to IVF/GIFT, $33,433. Total capitated payments, including copayments, was $126,256 under the reproductive medicine agreement and $32,891 under the infertility rider. This resulted in a 71% gross collections rate. CONCLUSION(S): This study indicates that entering into a capitated health care plan to provide an infertility benefit can produce a successful result.

Adolescent↗
PubMed2004

What is social capital and how does it relate to health?

During the last 25 years, a new term has cropped up in social sciences, social capital. In the last 10 years, this term acquired a new dimension which relates it to health. Following an analysis of theoretical issues surrounding social capital and social support, recent research is used to illustrate how these are affecting health. It is argued that more theoretical development is needed before social capital can be used to form a new community nursing practice. Until then, the ideas of social capital (social contact, companionship, etc.) may guide our mode of operation during nursing interventions.

Community Health Nursing↗
PubMed2003

Social capital and the miniaturization of community among daily and intermittent smokers: a population-based study.

BACKGROUND: The impact of social participation, trust, and the miniaturization of community on daily and intermittent smoking was investigated. METHODS: The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the association between the social capital variables and daily and intermittent smoking. The multivariate analysis was performed by using a logistic regression model to investigate the importance of possible confounders (age, country of origin, education, and snuff consumption) on the differences in daily and intermittent smoking between high versus low social participation, trust, and their four combination categories. The differences in the prevalences of the 13 social participation subitems between the high social capital and miniaturization of community categories were compared by t tests. RESULTS: Daily smoking is negatively associated with both social participation and trust, while intermittent smoking is positively associated with social participation and negatively associated with trust. This latter combination, named "the miniaturization of community," is an indirect measure of the ideologically and culturally increasingly narrow forms of social participation that excludes generalised trust to other people. Study circles, meetings of organisations, theatre/cinema, arts exhibition, and gathering of relatives are more prevalent in the high social capital category, while visit(s) to night club/entertainment is more prevalent in the miniaturization of community category. CONCLUSIONS: Low social capital is associated with daily smoking. "The miniaturization of community," i.e., high social participation and low trust, is significantly associated with intermittent smoking. The results have direct implications for smoking prevention strategies.

Adult↗