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PubMed2005

You have more capital than you think.

Senior executives typically delegate the responsibility for managing a firm's derivatives portfolio to in-house financial experts and the company's financial advisers. That's a strategic blunder, argues this Nobel laureate, because the inventiveness of modern financial markets makes it possible for companies to double or even triple their capacity to invest in their strategic assets and competencies. Risks fall into two categories: either a company adds value by assuming them on behalf of its shareholders or it does not. By hedging or insuring against non-value-adding risks with derivative securities and contracts, thereby removing them from what the author calls the risk balance sheet, managers can release equity capital for assuming more value-adding risk. This is not just a theoretical possibility. One innovation-the interest rate swap, introduced about 20 years ago-has already enabled the banking industry to dramatically increase its capacity for adding value to each dollar of invested equity capital. With the range of derivative instruments growing, there is no reason why other companies could not similarly remove strategic risks, potentially creating billions of dollars in shareholder value. The possibilities are especially important for private companies that have no access to public equity markets and therefore cannot easily increase their equity capital by issuing more shares. The author describes how derivative contracts of various kinds are already being employed strategically to mitigate or eliminate various risks. He also shows how companies can use the risk balance sheet to identify risks they should not bear directly and to determine how much equity capacity they can release for assuming more value-adding risk.

Capital Financing↗
PubMed1990

Corporal and capital punishment of juveniles.

There is a previously unobserved connection between corporal punishment of public school children and capital punishment of juveniles. Both are barometers of acceptable levels of violent punishment and their elimination is a hallmark of a maturing and decent society. Within a majority of the eighteen states where school authorities most frequently strike children are housed 25 of the nation's 28 juvenile death row inmates. On average, the homicide rates of these jurisdictions are two and a half times greater than those that have abolished both state-sanctioned corporal and capital punishment or limit death sentences to those age eighteen and older at the time of their crime(s). Most of the eighteen state abolitions of corporal punishment occurred in the 1980's. The US Supreme Court has ruled both corporal and capital punishment of juveniles constitutional. Additional state legislative abolition of both is anticipated in the 1990s.

Adolescent↗
PubMed1990

Biased selection under the senior health plan prior use capitation formula.

A widely acknowledged shortcoming of the current AAPCC capitation formula for Medicare HMOs is its inability to adjust capitation levels for differences in health status among enrolled groups. Prior use models have been proposed as one alternative to the current AAPCC risk classes. From 1984 through 1987, Senior Health Plan (SHP) participated in a HCFA-sponsored demonstration project in which capitation payments were determined by a prior use formula incorporating information on inpatient hospital days and Part B deductibles. This paper contains findings about selection bias in SHP enrollment from analyses of preenrollment reimbursements and postenrollment mortality rates of SHP enrollees compared with Medicare FFS beneficiaries and enrollees of other Medicare HMOs in the Minneapolis-St. Paul area.

Capitation Fee↗
PubMed1990

CEOs: keep capital fold-in out of budget politics.

Hospital CEOs don't want to see Medicare capital reimbursement fall victim to budget politics. Yet, that's likely to happen if the Health Care Financing Administration folds capital reimbursement into the prospective pricing system (PPS), CEOs say. Moreover, the majority of CEOs say that no fair method of including capital payments in PPS rates can be developed.

Attitude of Health Personnel↗
PubMed1990

Attitudes of Washington State primary care physicians toward capitation-based insurance plans.

Recent years have brought many changes in health care financing, including health care insurance plans based on capitation allowances to physicians. This study describes a survey examining physician attitudes toward such plans. The survey was distributed to a random sample of 30% of the family physicians, general practitioners, general internists, and general pediatricians in the Washington State Medical Association in 1986. Responses from 322 physicians (71%) indicated that most primary care physicians had a negative attitude toward such plans. Participants in capitation-based plans (48% of total respondents) had a nearly neutral attitude, which was significantly different from the attitude of nonparticipants. Respondents identified the main disadvantages of such plans as confusion about benefits, increased administrative demands, liability risks, altered professional relationships, and loss of autonomy. The main advantages perceived were increased physician awareness of cost, increased importance of the primary care role, and reduction of unnecessary health care utilization. Attitudes were significantly more negative among solo practitioners and physicians with more years in practice. Respondents rated selection of consultants, favorable economic arrangements, and benefits information as the features most likely to influence them to participate in capitation-based plans.

Attitude of Health Personnel↗
PubMed1986

An evaluation of current approaches to nursing home capital reimbursement.

One of the more controversial issues in reimbursement policy is how to set the capital cost component of facilities rates. In this article we examine in detail the various approaches used by states to reimburse nursing homes for capital costs. We conclude that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates. When properly designed, fair rental systems should provide more rational incentives and less encouragement of property manipulation than do more traditional systems, with little or no increase in state costs.

Capital Financing↗
PubMed1988

Prospective payment for capital: an examination of current issues.

Congress has suggested that a prospective payment system for capital should permit the continuation of cost-based reimbursement for certain projects. A study was conducted to examine the components of the capital planning process used by eight hospitals and the effect of this process on completion of capital projects.

Capital Financing↗
PubMed1988

Physician knowledge and attitudes about health insurance after the introduction of capitated health care plans.

A two-part closed-end survey similar to a survey done in 1980 was given to 25 family physicians at an academic family medical center to assess physician knowledge about five insurance programs covering most of the patients seeking care in the center, and to assess physician attitudes about the capitated insurance plan with which the clinic was affiliated. Results did not differ significantly from those obtained in a similar survey four years earlier at the same center. Physicians correctly identified benefits offered by insurance programs only about one half of the time and many did not ascertain patient insurance coverage at all. Physicians considered the most important advantages of capitated health care to be the patient protection from fees for services obtained, the coverage for health care maintenance, and the potential for controlling health care costs. Physician-perceived disadvantages included difficulties controlling costs generated by other specialists, dealing with after-the-fact authorization requests, controlling access to services, and obtaining information about costs within the capitated system.

Attitude of Health Personnel↗
PubMed1985

Heckler v. Chaney: judicial and administrative regulation of capital punishment by lethal injection.

Capital punishment by lethal injection, which was expected to be the most safe and effective of available methods, can produce unusually cruel and inhuman death. In Heckler v. Chaney, inmates sentenced to death by lethal injection, as well as members of both the medical and legal communities, challenged the Food and Drug Administration's (FDA) refusal to regulate certain drugs used for capital punishment by lethal injection. By declining to review the FDA's nonenforcement decision, the Supreme Court also declined an opportunity to reevaluate its standard for determining cruel and unusual punishment, which upholds any method of execution that is no more unusually cruel than existing methods. This Comment examines the propriety of judicial and administrative regulation of capital punishment by lethal injection.

Capital Punishment↗
PubMed1984

Capitation payment for pharmacy services. I. Impact on drug use and pharmacist dispensing behavior.

Results of a two-county pilot study in Iowa revealed that capitation may have significant advantages over fee-for-service (FFS) reimbursement in the Medicaid drug program. Consequently, the capitation program was expanded to 32 counties on April 1, 1981 and continued through December 31, 1981. Another 32 counties were used as part of a before:after/experimental:control design. Pharmacists were paid 80% of projected drug expenditures in advance based on the types of Medicaid eligibles who chose them as their providers. The remaining 20% was withheld in an escrow account to be used for supplemental, emergency, and bonus payments. Pharmacists who participated in this experiment were guaranteed that their gross profits on Medicaid prescriptions would remain at least equal to what they would have been if they had remained under the current FFS payment system. Major differences in drug use levels and pharmacist dispensing behavior under capitation financing were observed in the pilot study. However, no such changes associated with payment type were noted in the expanded program. Relative to these findings, a discussion of pharmacist attitudes is presented.

Attitude of Health Personnel↗
PubMed1994

Resource costs of capitation maintenance care in Britain.

The aims of this study were to examine variations in the resource cost of maintenance care for children under capitation by the area in which the dentist worked, the gender of the dentist, the number of years that the dentist had been qualified and the social class mix of the practice locality. Data were analysed from those collected during a clinical trial of capitation and fee-for-service payment systems that took place between 1986 and 1989. The costs of restorative/surgical treatment were over twice as high in Grampian than in Bromley. The costs of all treatment provided were 46 per cent higher in Salford than in Bromley. The date of qualification of the dentist was the only factor significantly associated with the cost of preventive treatment provided, with more recent graduates offering more preventive care than older dentists. The difficulties of using uniform national capitation rates are discussed.

Adolescent↗
PubMed1995

Acceptability to general practitioners of national health insurance and capitation as a reimbursement mechanism.

OBJECTIVE: To determine general practitioners' attitudes to national health insurance (NHI) and to capitation as a mechanism of reimbursement. To explore determinants of these attitudes. DESIGN: Cross-sectional survey by means of telephone interviews; four focus group discussions. SETTING: Cape Peninsula. PARTICIPANTS: 174 GPs randomly sampled from a total population of 874. MAIN OUTCOME MEASURES: Acceptance of NHI, acceptance of capitation. MAIN RESULTS: 63.3% approved of NHI. More than 81% approved of NHI if GPs would be able to maintain their independent status, e.g. own premises and working hours; 82.3% said NHI would be a more equitable system of health care, 88% approved of the fact that NHI would make care by GPs more accessible, and 73% said they would have the capacity to treat more patients. However, 61.3% of GPs disapproved of capitation as a form of reimbursement. CONCLUSIONS: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, the proportion of GPs who approved the introduction of NHI varied depending on details of the NHI system such as payment mechanisms, workload, income and effects on professional autonomy. A national survey of medical practitioners is recommended. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI system in South Africa require serious consideration by policy-makers.

Adult↗
PubMed1996

Capitation begins to transform the face of American medicine.

Canadian physicians only need look to the south to see that capitation can control not only their fees but also the amount of resources they use, the amount of care their patients can expect and the way doctors and patients relate to one another. In the US, capitation is rewarding doctors for doing less and penalizing them if they do too much. "Instead of a being cash source," says Dr. John Verhoff, a family practitioner in Columbus, Ohio, "a patient visit is a cash drain." Milan Korcok looks at the ways capitation is changing medicine in the US.

Aged↗
PubMedDate not supplied

Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods.

OBJECTIVE: To compare performance of different health status measures for risk-adjusting capitation rates. DESIGN: Cross-sectional study. Health status measures derived from 1 year were used to predict resources for that year and the next. SETTING: Group-network health maintenance organization in Minnesota. PARTICIPANTS: Sample of 18- to 64-year-old (n=3825) and elderly (aged > or = 65 years; n=1955) members enrolled in a network-model health maintenance organization in Minnesota. MAIN OUTCOME MEASURES: Total expenditures in the year concurrent with the health status survey (July 1991 through June 1992) and total expenditures in the year following the survey (July 1992 through June 1993). RESULTS: Capitation adjustment based on demographic measures performed least well. Both self-reported health status measures and diagnoses predicted future expenditures twice as well as demographics. When predicting costs for groups of patients rather than individuals, the demographic model worked well for average groups but tended to overpredict healthier groups and underpredict sicker groups. Ambulatory Care Groups based on diagnoses performed better than self-reported health status both in the retrospective models and across healthier and sicker groups. CONCLUSIONS: Without risk adjustment, capitation rates are likely to overpay or underpay physicians for certain patient groups. It is possible to improve prediction using health status measures for risk adjustment. When selection bias is suspected and administrative data are available, we recommend a risk-adjustment method based on diagnostic information. If diagnostic data are not available, we recommend a system based on simple self-reported measures, such as chronic conditions, rather than complex functional status measures.

Adult↗
PubMed1997

How can vascular surgery survive capitated care?

The basic differences between fee-for-service and capitated care are characterized and how they are likely to impact the practicing vascular surgeon are explored. Likely practice scenarios under capitated care are given. If the potential problems associated with using primary care "gate keeper" physicians materialize, secondary "carveouts" by vascular specialists may prove feasible. The alternative, particularly in large patient care consortiums, is to educate gatekeepers with efficient management algorythms in exchange for appropriate referrals. In spite of demonstrable flaws and abuses, capitated, managed care is likely to persist in some form, as an effective way to control spiraling health care costs. Therefore, vascular surgeons need to be prepared to compete under such systems. The major keys to success are efficient use of diagnostic tests, applying conservative, cost conscious indications for intervention, and efficient use of hospital resources (judged by lengths of stay in the intensive care unit and hospital and readmissions under the same diagnosis). In addition to developing better practice profiles, in these and standard mortality and morbity parameters, vascular surgeons need to create or join an efficient practice environment, with a minimum number of efficient personnel and teaching and research costs tightly controlled. To negotiate contracts effectively, vascular surgeons must know their costs, of delivering care on a per capita basis in their environment, adjusted for specific (eg, working or retired) patient populations. Outcomes and cost comparisons and other management research must vie for attention with new technology and basic research.

Capitation Fee↗
PubMedDate not supplied

Willingness to pay and cost of illness for changes in health capital depreciation.

The paper investigates the relationship between the willingness to pay and the cost of illness approach with respect to the evaluation of economic burden due to adverse health effects. The basic intertemporal framework is provided by Grossman's pure investment model, while effects on individual morbidity are taken to be generated by marginal changes in the rate of health capital depreciation. More specifically, both the simple example of purely temporary changes and the more general case of persistent variations in health capital depreciation are discussed. The analysis generates two principal findings. First, for a class of identical individuals cost as measured by the cost of illness approach is demonstrated to provide a lower bound on the true welfare cost to the individual, i.e. cost as given by the willingness to pay approach. Moreover, the cost of illness is increasing in the size of the welfare loss. Second, if one takes into account the possible heterogeneity of individuals, a clear relationship between the cost values supplied by the two approaches no longer exists. As an example, the impact of variations in either financial wealth or health capital endowment is discussed. Thus, diversity in individual type turns out to blur the link between cost of illness and the true economic cost.

Attitude to Health↗
PubMed2005

Are Kirindy sifaka capital or income breeders? It depends.

The capital and income breeding framework has only recently been used to explain variation in female reproductive strategies in primates. The application of this framework to primates and other mammals with long reproductive cycles has not been consistent. We evaluated data on Verreaux's sifaka (Propithecus verreauxi verreauxi) in the Kirindy Forest of western Madagascar to determine whether they are capital or income breeders. We found that Verreaux's sifaka can be classified as either capital or income breeders, depending on how these concepts are operationalized. These conflicting findings highlight why the capital/income framework is currently problematic and must be standardized if it is to be a useful framework for primatologists.

Animals↗
PubMed1983

The capitate of Australopithecus afarensis and A. africanus.

The capitates of Australopithecus afarensis (AL 288-lw and AL 333-40) and A. africanus (TM 1526) have the identical combination of modern pongid, modern hominid, and unique characteristics. These traits include the combination of a length that is proximodistally shortened (Homo sapiens-like), a facet for the second metacarpal that is distolaterally facing (unique), the reduced styloid process on the third metacarpal (pongidlike), a dorsally placed trapezoid facet (pongidlike), mediolaterally constricted metacarpal III facet (pongidlike), a prominent palmar beak (pongidlike), a single elongated facet for the second metacarpal (H. sapiens-like), a waisted neck (pongidlike), and a reduced amount of "cupping" in the third metacarpal facet (H. sapiens-like). In overall shape the bones are more like H. sapiens than other extant hominids, although they are uniquely different. The two A. afarensis capitates provide no evidence that there are two postcranial morphotypes at Hadar. Available evidence shows that A. afarensis and A. africanus are strikingly similar postcranially. The morphological differences between the capitate of Australopithecus and H. sapiens may relate to the retention of climbing ability and an absence of certain grip capabilities in these early hominids.

Animals↗