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At least 487 records · Page 27Linked to original sources
PubMed1997

An assessment of capitation in the General Dental Service contract 2. Patterns of treatment provided to regularly attending patients.

OBJECTIVE: To compare the patterns of treatment of general dental practitioners working under fee-for-service in 1987/88 with those working under capitation in 1992/93. DESIGN: 73 randomly selected general dental practitioners working under capitation in three contrasting areas in England retrospectively recorded the treatment provided during 1992/93 to a random selection of their regularly attending 6-12- and 14-15-year-old patients. RESULTS: Mean numbers of examinations per year reduced in the three areas from 1.7-1.8 in 1987/88 to 1.2-1.4 in 1992/93. Mean numbers of visits per patient dropped from 2.5-2.9 to 1.8-2.2. Mean numbers of fillings in permanent teeth reduced from 0.15-1.04 to 0.09-0.52 and in deciduous teeth from 0.28-0.53 to 0.24-0.31. Mean percentages of children per dentist having extractions fell from 9.3-28.1% to 4.7-16.2% while the radiographs reduced from 14.0-9.0% to 6.0-10.6%. Mean percentages of children per dentist receiving oral hygiene instruction rose from 18-31% in 1987/88 to 26-33% in 1992/93. Dietary advice increased from 3-18% to 11-20% and fissure sealants from 3-6% to 3-12%. CONCLUSIONS: In 1992/93, dentists working under capitation were carrying out fewer examinations, fillings and extractions and were taking fewer radiographs for their regularly attending child and adolescent patients than dentists working under fee-for-service in 1987/88. These patients also attended less frequently for treatment but received marginally more preventive care and advice.

Adolescent↗
PubMed1998

Levels of restorative care under capitation.

OBJECTIVES: 1. To compare the prevalences of fissure sealants in similar groups of 14-15-year-old, regularly-attending patients treated under fee-for-service in 1989 and capitation in 1994. 2. To calculate the effect of including sealants in the restorative index on estimates of interventional treatment carried out on 14-15-year-old regularly attending patients treated by general dental practitioners in 1994. DESIGN: A randomised epidemiological study. SETTING: Secondary schools in the Wycombe, Doncaster and Hereford/Worcester areas. METHOD: Random samples of 14-15-year-old, regularly attending patients treated by dentists practising under capitation in three contrasting areas of England were examined in 1994 for the presence of decayed, missing and filled teeth and fissure sealants. Restorative indices were calculated with and without the inclusion of sealants. The latter were compared with restorative indices calculated without the inclusion of sealants on regularly attending patients of the same age group when the dentists in the same three areas were working under fee-for-service in 1989. RESULTS: The prevalence of fissure sealants increased between 1989 and 1994 from 16% to 30% in Wycombe, from 13% to 50% in Doncaster and from 25% to 47% in Hereford/Worcester. Without fissure sealants the restorative indices fell between 1989 and 1994 from a range of 76.5-94.4 to 63.3-87.1. When sealants were included in the restorative indices for 1994, they ranged from 79.5-92.9. CONCLUSIONS: There were increases in the prevalences of fissure sealants between 1989-1994. When these sealants were included in the calculation of restorative indices for 1994, the level of restorative care provided by general dental practitioners remained relatively high since the introduction of capitation. Although there has been some increase in the level of untreated disease, if the restorative index is calculated without the inclusion of sealants then there is a risk of underestimating the treatment provided by general dental practitioners to control the carious process. Dentists appear to be redirecting their efforts into newer treatment/preventive items.

Adolescent↗
PubMed2004

[Smoking-attributable productivity loss in Germany--a partial sickness cost study based on the human capital potential method].

PURPOSE: Costs of productivity loss for the Federal Republic of Germany attributable to smoking in 1999 was to be determined. METHODS: Mortality and morbidity attributable to smoking is determined by a 0.5 % sample of the smoking behaviour of the German population (microcensus 1999) and the relative mortality risks of smokers (US-American cancer prevention study II). Tobacco smoke-associated cancer illnesses, cardiovascular diseases, respiratory tract diseases and illnesses of children under one year are considered. Calculation of the productivity-relevant consequences of smoking due to morbidity and mortality is effected according to the so-called human potential capital method. RESULTS: In Germany total of 607,393 working years were lost because of smoking in the year 1999. The costs of productivity loss are estimated at 14,480 billion euro. From this 4,525 billion euro are allotted to premature mortality, 5.759 billion euro to permanent disablement and 4.196 billion euro to temporary incapacitation for work. If the costs of productivity loss by smoking are referred to the gross national product (BSP) in the year 1999, an economical damage at a value of 0.74 % of BSPs results. This corresponds to a productivity loss of 379 euro per present or former smoker. The sensitivity analysis manifests that the inclusion of "non-marketable production" results in an immense rise productivity losses attributable to smoking. However, it should be noted that in times of mass unemployment the human capital method which is based on full employment does not measure the actual, but only the potential productivity loss cost. CONCLUSIONS: This partial disease cost study shows that immense economic productivity losses are associated with smoking. This loss of resources can justify a purposeful promotion of studies regarding cost effectiveness of anti-smoking therapeutic measures or preventive measures against smoking. But it should be considered that the use of the human potential capital method results in an overestimation of the actual productivity losses by smoking. In future the costs of productivity losses attributable to smoking should be determined by the friction cost method. With this procedure a more realistic estimation of productivity-relevant costs of smoking is possible.

Adult↗
PubMed2002

Capital investment in public hospitals.

Capital investment is a major concern for public hospitals. Relative to operating expenditures, it has been almost constant for 40 years, despite great changes in technology and patient throughputs. Research studies during the last decade suggest that over that time almost all investment has been on simply replacing existing assets. Per person, the total capital stock has actually declined. However most replacement outlays are predictable. Although major building outlays may still need some central supervision, equipment replacement can be projected with enough confidence to fund it through operating grants. Using data from several surveys, some capital-weighted DRGs have been developed and a funding system suggested.

Australia↗
PubMed2002

From disorganized capitalism to transnational fine tuning? Recent trends in wage development, industrial relations, and 'work' as a sociological category.

The disorganization thesis concentrates upon globalization and market dynamics, which are believed to trigger the breakdown of any kind of institutional structures. The diversity of capitalism approach, by contrast, places much emphasis on the persistence of distinct paths of national economies. Referring to comparative data from the OECD and other sources it is shown that some variables indicate a robustness of national styles of capitalism. Others hint at resemblance: e.g. there is a striking synchronization of the overall and sectoral wage development, there is a significant decrease in industrial disputes, and the class composition tends to become more similar. A move beyond the disorganization thesis and diversity of capitalism approach is suggested. Special attention should be paid to the profound impacts of transnational institutions and knowledge carriers in the form of experts and guidelines.

Capitalism↗
PubMed1983

Simultaneous financial evaluation of a complex set of capital budgeting alternatives: a mathematical model.

Capital budgeting technics provide for financial evaluation of planned purchases of equipment or other major investments. In capital budgeting, the laboratorian often is faced with a complex set of alternatives, including leasing, installment purchasing, contracting work to another laboratory, and outright purchasing. This paper presents a mathematical model useful for simultaneously evaluating the financial worth of all such alternatives under the same set of assumptions. Armed with the results of financial evaluation and evaluations of quality, turnaround time, and other patient-care factors, the laboratorian can make better decisions regarding the choice of method which, in turn, will affect the productivity of the laboratory. The model is tended for application to mutually exclusive alternatives and includes three useful capital budgeting technics: (1) payback period, (2) net present value, and (3) profitability index. The technics are demonstrated as well as a method of programming the model in financial planning software for solution by microcomputer.

Budgets↗
PubMed1984

A proposal for capital cost payment.

This article proposes new bases for the payment of hospital capital costs. Separate distinctions between proprietary and voluntary hospitals are made based on their definition of capital and the requirements for capital maintenance. Replacement cost depreciation is suggested as the payment basis for voluntary hospitals.

Capital Expenditures↗
PubMed1989

Adjusting employer group capitation premiums by Community Rating by class factors.

Community rating of employer group health maintenance organization (HMO) capitation premiums results in low premiums for some groups and high premiums for other groups, as compared with the marginal costs of providing services. In effect, low health risk groups are cross subsidizing high health-risk groups in an HMO. This has caused several inefficiencies in the health plan marketplace, which have directly benefited higher-risk groups. For this reason, certain low-risk groups are searching for new strategies to improve market efficiency. One strategy is Community Rating by Class (CRC), a system which adjusts community rated capitation premiums by broad-based risk factors. This article examines CRC as a strategy to help reduce the inefficiencies caused by current federal regulations. In regressions predicting future year total family health expenditures, the CRC Model achieved an R2 value of 0.211. This value was over half the R2 value of an experience rated approach, based on prior year utilization and expenditure variables. Family size accounted for 80% of the variance explained by the CRC Model. The results indicate that the CRC rating approach may be a good mechanism to correct for cross subsidization of employer group capitation premiums.

Adolescent↗
PubMed1990

Access to office-based physicians under capitation reimbursement and Medicaid case management. Findings from the Children's Medicaid Program.

This study reports the effects of a voluntary Medicaid case-management demonstration on the primary care provided to young children by office-based physicians. The MDs who participated were reimbursed at rates higher than the regular Medicaid fee schedule, either through augmented fees for specific services or through monthly capitation payments. Using the Medicaid Management Information System (MMIS) claims data, we compared the rates at which children in the experimental program and children in the regular Medicaid program were seen by a physician during a one-year period. The majority of experimental children received regular and frequent care from primary care physicians during the demonstration. After controlling for race and prior utilization differences, we found that augmented fee-for-service children received more primary care from office-based physicians than children in the regular Medicaid program. Capitation children received at least the same amount of primary care as children in the regular Medicaid program. We interpret our data to mean that capitation payment, untied to the delivery of services, does not necessarily reduce access to primary care and that higher fees for physicians who treat children may, in fact, increase access.

Capitation Fee↗
PubMed1992

Ambulatory testing for capitation and fee-for-service patients in the same practice setting: relationship to outcomes.

Previous studies of the impact of varying reimbursement incentives on physician behavior have not explored the simultaneous implications for patients' health outcomes. Using a single group of physicians who provided care for hypertensive patients with either capitation (N = 99) or fee-for-service (N = 66) health insurance plans, physicians' test-ordering behavior and patients' subsequent health outcomes were examined. After controlling for patients' age, severity of hypertension, and level of comorbidity, it was found that patients with capitation health insurance had fewer laboratory tests and lower overall charges than the fee-for-service patients, with no clinical or statistically significant differences in 1-year health outcomes, specifically blood pressure control. The study concludes that capitation can result in reduction in charges associated with management of hypertension, without apparent compromise in proximate health outcomes.

Adult↗
PubMed1999

Pharmacy costs groups: a risk-adjuster for capitation payments based on the use of prescribed drugs.

BACKGROUND: Adequate risk-adjustment is critical to the success of market-oriented health care reforms in many countries. A common element of these reforms is that consumers may choose among competing health insurers, which are largely financed through premium-replacing capitation payments mostly based on demographic variables. These very crude health indicators do not reflect expected costs accurately. OBJECTIVE: This study examines whether the demographic capitation model can be improved by incorporating information on the presence of chronic conditions deduced from the use of prescribed drugs. The revised Chronic Disease Score was used to incorporate this information in the model. METHODS: A panel data set comprising annual costs and information on prescribed drugs for 3 successive years from Dutch sickness fund members of all ages, is used for the empirical analyses (N = 55,907). The predictive performance of the demographic model is compared with that of a chronic conditions and a Pharmacy Costs Groups (PCG) model, which is a demographic model extended with information on clustered chronic conditions. RESULTS: The predictive accuracy of the demographic model substantially improved when the model was extended with dummy variables for chronic conditions. The 23 chronic conditions could be clustered into six PCGs without affecting the predictive accuracy. Based on these PCGs 17% of the members were bad risks with a mean predictable loss that exceeds the overall average expenditures. CONCLUSIONS: The use of information on chronic conditions derived from claims for prescribed drugs is a promising option for improving the system of risk-adjusted capitation payments.

Capitation Fee↗
PubMed1996

The capitation revolution in health care: implications for the field of nursing.

Health care is being reformed in the United States. However, rather than the reform taking the course of the rejected Clinton health care plan, the invisible hand of the free market is reshaping America's health care sector through the spread of a system known as capitation. This article looks at capitation and its effect on hospitals, which are rapidly adopting this practice. Then it explores the implications for both nurses and nursing administration as hospitals seek to transform themselves into health care delivery systems. It is suggested that hospitals bring nurses and nurse administrators to the forefront on their concerns in setting up such capitated systems.

Capitation Fee↗
PubMed1996

A capitation primer for pediatricians.

This paper discusses the basic issues involved in capitation contracting for pediatricians. We provide a blueprint for analyzing capitation arrangements. We begin by reviewing the basic concepts of capitation. We then discuss contract features, underwriting and pricing risks, administration, risk assessment and management, and finally quality of care considerations.

Capitation Fee↗
PubMed2006

Case reports: osteonecrosis of the capitate: a pediatric case report.

We present what we think is the first documented occurrence of osteonecrosis of the capitate in a skeletally immature patient. Atraumatic osteonecrosis of the capitate is rare, and all reported cases have occurred in adults. Our pediatric patient was treated with observation and limited immobilization. He achieved a full recovery clinically and radiographically after 1 year. A review of the literature pertaining to osteonecrosis of the capitate also is provided.

Capitate Bone↗
PubMed2007

Caregivers' ratings of access: do children with special health care needs fare better under fee-for-service or partially capitated managed care?

OBJECTIVE: The objective of this study was to evaluate how enrollment in a partially capitated managed care (MC) option versus the fee-for-service (FFS) system affects caregivers' ratings of dimensions of access to services among children with special health care needs (SHCN). SUBJECTS: The data were collected from telephone interviews during the summer and fall of 2002 with a random sample of 1088 caregivers of children with SHCN who qualified for Supplemental Security Income and therefore were enrolled the Medicaid program for children with SHCN in the District of Columbia. RESEARCH DESIGN: We used a 2-step procedure in which we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias linked to plan choice. We estimated the second stage equations predicting caregiver's ratings of dimensions of access as a function of the selectivity correction, the plan choice dummy variable and other exogenous variables. RESULTS: After controlling for the potential selection bias linked to plan choice and other confounding factors, we find that caregivers of children in FFS are significantly more likely than caregivers of children enrolled in the partially capitated MC plan to rate the following dimensions of access as either fair or poor: "access to specialists' care" (P < 0.01), "access to emergency room care" (P < 0.01), "convenience of the doctor's office" (P < 0.01), and "waiting time between making the appointment actual visit" (P < 0.05). CONCLUSIONS: We attribute these differences in caregivers' ratings of dimensions of access that exist between partially capitated MC and FFS enrollees to case management and care coordination services along with higher fees paid for pediatrician's and specialists' services available under MC option.

Capitation Fee↗
PubMed2004

The impact of capitation on physician organizations' cost structures: an exploratory analysis.

This paper aims to evaluate the relationship between capitation payment methodology and the physician organization cost function. The paper provides evidence supporting a positive relationship between overhead rates and the level of capitation. Based on sample data, US medical practices whose net medical revenue consists of 11 percent or more capitation payments have significantly higher overhead costs per physician FTE.

Capitation Fee↗
PubMed2005

Capitated Medicaid managed care in a rural area: the impact of Minnesota's PMAP program.

CONTEXT: Although states have had difficulty extending Medicaid managed care (MMC) to rural areas, rural models of capitated MMC are expected to grow in response to new federal regulations and the serious budget problems facing nearly all states. As such, understanding the effects of capitated MMC in rural settings is important for policy considerations. PURPOSE: To evaluate the effects of capitated MMC on beneficiary access and use in rural Minnesota. METHODS: We took advantage of delays in the timing of the introduction of MMC across rural counties in Minnesota to estimate the effects of managed care on adults and children under Medicaid using a difference-in-differences framework. FINDINGS: We found that Minnesota's shift from fee-for-service Medicaid to MMC in its rural counties had little effect on access to health care for either adults or children. CONCLUSIONS: Because Minnesota reports that Medicaid costs under MMC are below expected costs under FFS Medicaid, it appears that the primary accomplishment of Minnesota's rural MMC initiative is one of cost savings: MMC provides the same access to care as FFS Medicaid, but at lower cost. With steep budget deficits in nearly all states, other states may want to consider Minnesota's rural MMC model as a mechanism for reducing their Medicaid costs.

Adult↗
PubMed1996

Capitated contracting in radiology: negotiating techniques, financial calculations, and utilization management.

The authors describe how to develop and manage a capitated outpatient radiology contract. Aspects of a capitated fee structure and the need to apportion fees between a hospital and its radiology group are discussed. During negotiations with a managed care organization (MCO), certain information and commitments should be obtained. Utilization data should also be obtained from the MCO, but if they are not available (or are thought to be unreliable), certain norms can be used. Once a utilization projection is arrived at, reimbursement calculations can be made and compared with assumed reimbursements under a known fee schedule, such as that of Medicare. This procedure allows one to estimate whether a capitated proposal is financially feasible. Once a contractual agreement is instituted, the radiology group must then track and manage utilization. An understanding of these principles should enable radiologists to deal effectively with both practice and fiscal concerns presented by managed care.

Adult↗