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PubMed1990

A model of capitation.

This paper presents a theoretical model of capitation contracts. The consumer's ex ante choice of medical plan is derived under flexible assumptions about provider-patient decision-making. The optimal medical plan is shown to combine full insurance with a provider payment system that is a mixture of capitation and partial reimbursement of provider costs. This solution strongly parallels the 'mixed payment' system derived by Ellis and McGuire (1986, 1990) in the context of prospective payment, though the optimal medical plan derived below may in fact be preferred to that solution in a world with endogenous admissions.

Capitation Fee↗
PubMed2005

Malignant melanoma with metastasis into the capitate.

Metastases to the hand and wrist are rare, with fewer than 200 cases reported in the literature. Phalanges are more commonly involved than metacarpal and wrist. The lung, breast and kidneys are the more common sites of primary lesions than metastasize in the hand. We present an exceptional case of melanoma that metastasized to the capitate. Melanoma can give bone metastases, but we are not aware of reports of this tumour metastatising to the carpal bones. In our knowledge, we have only found a report of metastases in the capitate, a clear-cell sarcoma of the right foot, a tumour close to melanoma with some cytogenetic differences. Hand metastases in a patient who is suffered melanoma should be ruled out if a lytic aggressive lesion appears on x-ray film or positive technetium bone scan is demonstrated.

Adult↗
PubMed2007

Development of a capitation scale for IDF career soldiers in Israel.

The Israeli National Health Insurance Law allocates a national healthcare budget to the sickness funds, which provide medical care to civilian population. Medical care for members of the IDF is financed through the budget of the Ministry of Defense and is not included in the national healthcare budget. Benefits provided to soldiers serving in the permanent forces are far more extensive than those provided to civilians. Because of no co-payments, poor management, and the cost-based budget, military healthcare costs in Israel are expected to exceed civilian healthcare costs, adjusting for age and sex. The present paper derives age- and sex-based capitation rates for military personnel, and compares military and civilian age-based expenditure and capitation rates. The study population comprised career soldiers and civilians aged 21-54 years. Expenses of career soldiers were calculated to provide information on the financial costs of medical services for each age group in 2003. Overall expenses for women were higher than for men in all age groups. As anticipated, the older the group, the higher the total expenditure for both men and women. In-patient care represented a higher percentage of the total costs for men (28.3%) than for women (22.1%). Emergency room care was higher for women in the 22-24 age group but comparable to that of men in higher age groups. Specialist visits represented a significantly higher percentage of the total costs for women than for men in the 22-24 and 25-34 age groups (by 6% and 15%, respectively). The difference decreased to 13% in the 35-44 age groups and, in the 45-54 age group, the difference for men was 14% higher than for women. Military costs were similar to civilian costs in the 22-24 age groups, higher in the following two groups, and lower in the 45-54 age group. Like in other organizations, military healthcare services might benefit from outsourcing. The inequality in medical services to soldiers and civilians, the over-use of the military healthcare system, and the decrease of standards and budgetary resources will compel the establishment of more creative means of providing these services through contracts and agreements, perhaps through the civilian sickness funds.

Adult↗
PubMed2000

Global capitation at a women's health referral center: the challenge of patient selection.

Global risk capitation as a preferred payment method in heavily penetrated managed care markets poses important challenges for women's health care tertiary referral centers that employ participating primary care physicians. Global risk capitation agreements expose those centers to the adverse financial effects of high frequency of obstetric visits, costly infertility and neonatal care, and care of a disproportionate number of patients with complex, resource-intensive conditions.

Capitation Fee↗
PubMed1990

A survey of the attitudes of physician specialists toward capitation-based health plans with primary care gatekeepers.

A survey of 414 Washington state physicians board certified in one of seven non-primary care specialties (gastroenterology, cardiology, dermatology, otolaryngology, orthopedics, psychiatry, and general surgery) assessed physician attitudes towards capitation-based health plans with primary care gatekeepers. Responses indicated significant differences in attitude according to specialty. Negative attitudes were more prevalent among physicians in solo practices and those practicing in smaller communities and were related to quality of care provided, lack of information regarding benefits, loss of physician autonomy, and heavy administrative demands in these plans. Although most respondents disapproved of capitation-based health plans, a significant number agreed that gatekeeper-based plans serve to increase public awareness about health care costs as well as to control health care costs.

Attitude of Health Personnel↗
PubMed2000

Quality incentives in a regulated market with imperfect information and switching costs: capitation in general practice.

We model a system akin to the British National Health Service (NHS), in which general practictioners (GPs) are paid by capitation from general taxation. GPs are horizontally and vertically differentiated and compete for patients via their imperfect observed quality. We show that for any given capitation fee quality is lower and the incentive effects of the fee on quality are smaller when there is imperfect information. There are diminishing welfare gains from improving patient information but increasing welfare gains from reducing switching costs. GPs do not act efficiently to improve patient information via advertising or to reduce the costs of switching.

Capitation Fee↗
PubMed2001

Risk sharing as a supplement to imperfect capitation: a tradeoff between selection and efficiency.

This paper describes forms of risk sharing between insurers and the regulator in a competitive individual health insurance market with imperfectly risk-adjusted capitation payments. Risk sharing implies a reduction of an insurer's incentives for selection as well as for efficiency. In a theoretical analysis, we show how the optimal extent of risk sharing may depend on the weights the regulator assigns to these effects. Some countries employ outlier or proportional risk sharing as a supplement to demographic capitation payments. Our empirical results strongly suggest that other forms of risk sharing yield better tradeoffs between selection and efficiency.

Capitation Fee↗
PubMed1997

Impact of capitation on free-standing dialysis facilities: can you survive?

Proposed changes in the Medicare reimbursement method for end-stage renal disease (ESRD) patients prompted us to study the total cost of caring for the ESRD patients in northeast Indiana over a 1-year period. We hoped to ascertain the actual cost of caring for patients treated with different modalities, determine if we could compete in a capitated environment, and identify areas in which we might reduce these expenses. Six patients new to dialysis and 29 patients already receiving treatment underwent follow-up evaluation for 1 year. We tracked their cost of care for 1 year in the outpatient setting as well as in the hospital. We found the cost of caring for all patients was $43,044 per year. Patients new to dialysis cost $3,164 more to care for than patients already receiving dialysis treatment. Hospitalization expense was the primary component of that difference. Continuous ambulatory peritoneal dialysis (CAPD) patients were $14,570 less costly per year to care for than hemodialysis patients. This differential primarily related to decreased hospitalization. Vascular access expenses were a major component of both the outpatient and inpatient cost for hemodialysis patients. Our yearly expenditures for all patients compared with suggested capitated Medicare reimbursement rates suggested that our program could be successful in a new reimbursement model. Several areas of possible cost reduction were identified.

Aged↗
PubMed1997

Capitation in nephrology: the time has come.

Nephrology represents a powerful example of the impact of new medical technology; almost 200,000 patients are alive in the United States because of renal replacement therapy. However, ESRD patient morbidity and life expectancy are still serious concerns despite advances in medical treatment. A capitated payment system for end-stage renal disease (ESRD) could be a great benefit to the renal community as it would force us to rethink the way ESRD care is provided. By applying the concepts of integration of services, disease management, and case management to ESRD care under a capitated payment system, providers may be able to improve patient outcomes and overall well-being.

Capitation Fee↗
PubMed2002

Raising venture capital in the biopharma industry.

Raising venture capital (VC) is both an art and a science. Future entrepreneurs should carefully consider the various issues of VC financing that have a strong impact on the success of their business. In addition to attracting the best venture capital firms, these issues include such subtle but important points as the timing of financing (especially of the first round), external support sources, desirable qualities of a VC firm, amount to be raised, establishing a productive interface between the founders and the venture capitalists, and most importantly the effects of well-executed VC funding on hiring senior executives and scientific leaders.

Biopharmaceutics↗
PubMed1987

Reflections on medical technology as a special type of capital. Some implications for the hospital.

The classical equation for the production of goods and services, that is, the combination of labor, capital, and knowledge, constrained by the time dimension, may also be used to examine the production of medical and hospital services. However, this is qualified by the special nature of the "capital" used in health care, particularly medical technology. Because of the particular nature of health services, the adoption and the use of technology follows rules that are different from those in the industrial sphere. These differences are examined in some detail as are the implications for the health field in general, and for the hospitals where most of the new (and often costly) technology is located.

Capital Expenditures↗
PubMed1998

Consumer turnover in service utilization patterns: implications for capitated payment.

Risk-adjusted capitation rates based on a group's expected cost to a provider have been proposed to create incentives for including people with severe mental disabilities in managed healthcare systems. The most appropriate methods for classifying people according to levels of risk, however, have yet to be determined. This research employed cluster analysis statistical techniques to identify patterns of services delivered to a sample of 4,346 consumers in Ohio. Findings about the extent of client movement in and out of service clusters over time suggest caution in the implementation of risk-adjusted capitation plans, particularly those based primarily on past service utilization.

Capitation Fee↗
PubMed1997

A comparison of retained and appointed counsel in cases of capital murder.

We examined the role of counsel as a source of arbitrary and capricious sentencing in cases of capital murder. The method is a reanalysis of the data of Baldus, Woodworth, & Pulaski (1990) on 606 cases of capital murder in Georgia in the 1970s. Controlling for variables describing the character of the defendant and the circumstances of the crime, a death sentence was more likely when defense counsel was appointed rather than retained privately. This was a consequence primarily of the prosecutor's decision to seek a death sentence rather than jury bias in sentencing. Our data support the conclusion that sentencing under the Georgia statute was in the 1970s, and is today to some degree, arbitrary and capricious.

Bias↗
PubMed2004

Race and jurors' receptivity to mitigation in capital cases: the effect of jurors', defendants', and victims' race in combination.

This paper examines the variation in receptivity to mitigation evidence by capital jurors as it varies by the race of the juror, defendant, and victim individually and in combination. Attitudinal and racial characteristics from 865 respondents in the Capital Jury Project were used in the analysis. Using a generalized form of multiple regression, the respondent's receptivity to mitigation evidence was predicted and changes in receptivity were calculated as the race of the main trial participants (juror, defendant, and victim) were varied. Statistical controls were put in place for gender of respondent; respondent's perception of the dangerousness of the defendant, heinousness of the crime, and view of the defense attorney; respondent's formation of a premature sentencing decision; and whether the trial took place in a southern state jurisdiction. Results indicate that Black jurors in cases where a Black is charged with killing a White victim are chiefly responsible for the observed variance in receptivity to mitigation.

Black or African American↗
PubMed1990

The capitation study. 3. The views of participating dentists and the profession.

During the course of a 3-year parallel, controlled clinical trial comparing a capitation system of remuneration with fee-for-service for the dental care of children, the views of the dentists were gained through meetings, informal communication, and a structured questionnaire sent to every dentist in the study. The questionnaires completed by the dentists who had been in the study from the beginning were used in the analysis. The views of practice principals on practice administration were also gained. Dentists in capitation claimed to have greater clinical freedom than those in fee-for-service, but the system under test involved more practice administration. The trial allowed the two systems to be compared under limited, controlled conditions, thus benefiting any substantive scheme that might be developed from it.

Capitation Fee↗
PubMed1996

Stress in dental practice: a qualitative comparison of dentists working within the NHS and those working within an independent capitation scheme.

A qualitative research methodology was used to compare the stress experienced by dentists working under two different systems of remuneration. No absolute difference was found in the levels of stress experienced by the two groups, as measured by a questionnaire measure of stress experience. Both groups of dentists identified patient management, time pressures and staff and practice management as sources of stress, though the independent capitation scheme dentists felt that they were under less time pressure and faced considerably less paperwork. Techniques for stress management identified by the dentists were limited and symptom-focused. The results suggest that, for dentists at least, changing from NHS to an independent capitation scheme is of great benefit.

Adaptation, Psychological↗
PubMed1999

Shifting to capitation in primary care: what might the impact be in New Zealand?

Primary medical care in New Zealand has traditionally been delivered by general practitioners and funded by a mix of fee-for-service government subsidies, user part-charges and private payments. In 1998, New Zealand's national purchaser of publicly-funded health care, the Health Funding Authority, proposed to pay health service organisations capitation fees per enrolled patient, as well as fees-for-service for immunisations and some performance-related payments. This article considers the implications, drawing on theory and research from New Zealand and elsewhere, of different methods for paying general practitioners and other primary care professionals. The main focus is on whether giving a greater emphasis to capitation will lead to a fairer distribution of resources and better access to services for those groups of people who are not well served by the current system.

Adult↗
PubMed1999

Privatising general practice in Mongolia: a trial of needs-adjusted capitation.

Mongolia's family doctors have long been salaried government employees. The crisis caused by the break-up of the Soviet Bloc required the government to seek a balance between command and market economies, and this influenced the decision to introduce capitated private practice for family doctor services on a trial basis. This article explains why and how a risk-adjusted capitation model was developed by a blend of empirical analysis and expert judgement, which comprises ten classes of clients defined by age-sex and poverty groupings. Payment relativities across the classes were set in proportion to a desirable (or target) number of contacts per year. Separate processes were used to set the targets for patient-initiated and active (health promotion and illness prevention) contacts. The model is intended to lead to greater equity of service access and provision. It should also encourage a greater concern for health outcomes, sensitivity to clients' views, and operational efficiency.

Age Factors↗