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The scarce integration and coordination of treatment is considered to be a very important problem in our health system. Can capitation, which means something like "charging a fee on each citizen based on his/her treatment necessities" resolve this problem? Can capitation favor clinical and treatment integration?
Keystone Mercy Health Plan, Philadelphia, enhances its capitation contracting strategy by providing financial incentives for capitated primary care physicians to provide high-quality services.
Integrated delivery systems focus on service delivery after capitation efforts stall. Integrated delivery systems are going through changes that are focusing the provider organizations more on delivering care than managing risk, says Dean C. Coddington, one of the leading researchers into capitated organizations and a senior consultant with McManis Consulting in Denver.
An independent practice association has sued Humana Kansas City Inc. over the health plan's decision to terminate its capitated contract. The suit alleges breach of contract and seeks an injunction to keep the flow of capitated dollars coming.
Diagnostic imaging continues to place high demands on hospital and health system capital budgets due to the high cost of most equipment and the rate of technological change. Diagnostic imaging also can be a significant service in competitive positioning, both alone and in conjunction with other programs and services. The purpose of this article is to provide a framework for linking diagnostic imaging to key hospital programs, and for forecasting future demands and capital requirements. The model has been developed over time in a number of settings in the United States and Canada. The specific examples are mostly from the Seton Healthcore Network in Austin, TX.
We herein report the case of a 15-year-old boy with cystic lesion of the capitate. Magnetic resonance imaging showed that the lesion demonstrated homogenous low-intensity on T1-weighted imaging and homogenous high intensity on T2-weighted imaging. The lesion was treated by curettage and autologous bone-grafting. The histological specimen from the cystic wall showed loose fibrous tissue with capillary vessels and extravasated red blood cells. The cystic lesion was filled with blood, suggesting that the cystic lesion was actually an aneurysmal bone cyst. The present case is the second reported case of aneurysmal bone cyst of the capitate. No recurrence has been observed during the 4 years since operation. We also review the literature related to ABCs of the hand with special emphasis on local recurrence.
Modern dental capitation was conceived as being based on staff model group practice, receiving regular periodic payments to provide comprehensive care with few exclusions, limitations and copayments, to a given population. High utilization, completion and recall rates were expected. Examples are presented. The dominant form of capitation has become a network of solo and small group practices, usually with a for-profit intermediary. Premiums are low and administrative costs are high. There are many exclusions and limitations. Low utilization and under-treatment are endemic. Specific examples are presented. The reasons for this development include competition among dentists concerned about busyness, and predominance of cost control concerns over quality concerns on the part of purchasers.
This paper describes the development of a price index for hospital equipment. Based on 10 years of hospital capital acquisition data from a large teaching hospital, equipment acquisitions were categorized and weights derived for each category. Using national producer price indexes for each of these categories, a national hospital equipment index was derived for 1981 to 1991. Forecasts for 1991 and 1992 were then made. The resulting index indicated that price movements of our hospital capital equipment index were very similar to the Implicit Gross Domestic Product Deflator, an index that measures price changes for the nation's Gross Domestic Product. However, because of the relative importance of several categories of equipment (scientific instruments, computers), more widespread data on hospital equipment expenditure patterns would be desirable in order to validate these results.
The public review period for the Health Care Financing Administration's proposed regulation to fold capital payments to hospitals into the prospective payment system isn't over yet. But analysts are already saying HCFA's plan would hamper hospitals' ability to predict Medicare capital revenues. "The ability to make a long-range judgment about the regulation is difficult because we don't know the long-range picture. Even what they've [government officials] laid out for the first year is only an estimate," notes Paul Rettig, executive vice president of the American Hospital Association.
Capital formation will be a dominant issue for hospitals in the 1990s. A definitive new book, Hospital Capital Formation: Strategies and Tactics for the 1990s, examines the challenges in this area. A cover story to keep for your files.
The debate over whether and how to incorporate Medicare Part A capital payments into the prospective pricing system is beginning to seem like a political rerun, as the Health Care Financing Administration prepares its third proposed capital regulations. And once again hospitals are sprucing up opposing arguments to convince Congress that they are right and HCFA is wrong.
Capitation is an incentive-based form of payment for dental care. Unlike fee-for-service benefit plans, the nature of reimbursement in capitation plans provide dentists with the necessary incentives to perform appropriate and necessary level of care, seek less costly but effective alternatives, and place an emphasis on prevention. This paper examined how some of these incentives work and their effects on the practice of dentistry.
Capitation payment developed rapidly in the Liège area. The 1983 regulations were adopted by an existing health centre (Seraing) and two new health centres financed on capitation basis were created (Ougrée, Liège). It is now possible to distinguish amongst the theoretical factors those who had significant impact on the speed of growth. This is thus a kinetics study. The factors taken into consideration are, on demand side: demographic, sociographic, cultural, economic; and on supply side: quantity, quality of supply (diversity: age, sex, culture), organization of permanent care. The temporary conclusion is that demography of demand and quality of supply seem to be dominant factors for the kinetics. Viability of a health centre depends strongly of growth kinetics. There is a provisional instrument for creation of new health centres and their success.
This article presents results of a survey of chief financial officers at 294 hospitals in three states concerning their evaluation of capital investment proposals. The findings include capital budgeting methods used, treatment of risk, consideration and impact of qualitative factors, and participation of the medical staff.
The potential omission of indicated tests for patients enrolled in prepaid health care plans has been raised as a possibility. This study reviewed the charts of 149 adult patients seen for routine physical examinations or checkups in university-based family medicine or internal medicine clinics. Of the patients included, 67 were enrolled in a capitated plan and 82 enrolled in fee-for-service based plans. Results showed that the rates of compliance with preventive services appropriate to patients' age and sex (Papanicolaou smears, breast examination, mammography, and stool examination for occult blood) were not significantly different for capitated and fee-for-service patients.
Dentistry's mission has been defined as improving the oral health of the public. In the ADA's report on the strategic plan for dentistry, the first priority addressed is to convert public unmet needs into a demand for dental services. One of the methods which the plan has outlined for action is to "expand dental prepayment and promote growth of innovative payment mechanisms." The prepaid capitation method of payment can and will provide a vehicle to service those unmet needs. Healthcare insurance companies are organizing regional and national networks of individual practices who will accept this method of prepayment. As in all systems of delivery, there are possibilities for abuse. This article addresses a prepaid capitation delivery system from an operational perspective, in order to identify the elements that should safeguard the patient, dentist, employer group, and carrier.
This article is designed to help dentists make better decisions regarding capitation programs. It focuses on approaches to costs that can be useful. An example is given that illustrates how these cost concepts might be used to analyze a capitation proposal.
As the health care system becomes more impersonal, competitive, and cost conscious, there is a potential for increased dissatisfaction with health care providers. This paper describes the use of content analysis to examine aspects of patient dissatisfaction with delivery of health services in a capitated dental plan. All written complaints from three regions of California from June 1984 to June 1986 were collected, and a content analysis was performed on these letters. The rates of grievances differ substantially across regions; however, three regions were similar in their grievance patterns. Access to care was the single largest category of concern, and these grievances were registered because patients had to wait for an appointment (35 percent) or had to wait in the office (32 percent) to receive care. Provider technical competence was the second largest category. Significant variables from a logistic regression that predicts complaint status of an eligible member are (1) years covered, (2) age, and (3) income. The grievance rate and grievance categories described in this study can help define new strategies and policies in the overall mission of a dental capitation organization.