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PubMed1980

Network capitation practices: a new concept.

The percentage of consumers in the U. S. covered by dental insurance has increased dramatically over the last 10 years. As dental insurance grows, it is becoming increasingly important to examine the context of dental care payment systems. At present, almost all insurance programs are geared toward the fee-for-service system, which reimburses dentists a fixed sum for each type of procedure. The exceptions to fee-for-service dental insurance plans are few. A capitation program for dental care, which reimburses dentists a fixed amount per enrolled patient regardless of services rendered, offers many advantages for both consumers and providers and should be available as an option. Network capitation represents a new approach to the payment of dental care. A network capitation program is being developed in the United States and will use an approach involving two contracts, one which will be used with an insurance company, and the second with a network of private practitioners. The insurance company will supply dental practices with dental patients and funds on a capitation basis. Patients will be given the choice of fee-for-service or capitation. Network capitation allows fee-for-service solo or group practitioners to incorporate capitation patients into their practice.

Capitation Fee↗
PubMed1990

A comparison of quality in a dual-choice dental plan: capitation versus fee-for-service.

The quality of dental care provided under a dual-choice dental plan was evaluated. Eleven practices, six capitation and five fee-for-service, were examined. The methodology was based primarily on examination of elements of structure and process of care. Samples of patient dental records were drawn from each practice for a total of 495 patient records. The results showed that none of the five fee-for-service dental practices and only two of the capitation practices were found to meet all the criteria for acceptable dental practice. Universally poor documentation made it extremely difficult to evaluate process measures of care. Fee-for-service patients received more visits and services than capitation patients. Overtreatment occurred in fee-for-service practices and undertreatment occurred in capitation practices. The distribution of services also differed, with capitation practices providing a less expensive type of service. Annual utilization of one or more services for capitation practices varied substantially by the practice. In this plan, both capitation and fee-for-service practices demonstrated a need for strong quality assurance mechanisms to protect the interests of patients.

Adolescent↗
PubMed1988

The case for differential capitation fees based on age in British general practice.

A study was performed to assess whether the existing differential capitation fees for general practitioners accurately assess differential workloads. Data from the third morbidity study in general practice were used to compare capitation fees with relative workload in differing age and sex groups. The population mix which determined the payment by capitation for the 143 principals in the study provided the basis for examining the advantage or disadvantage the general practitioner got from the existing system. Capitation fees for the elderly underestimated the increased workload by 21% for those aged 65-74 and by 54% for those aged 75 or over but overestimated the workload for male adults aged up to 65. Nevertheless, 60% of the participating general practitioners were not advantaged or disadvantaged by more than 2.5% of their capitation fees (450 pounds a year for the average practitioner with a list of 2000 patients). Similarly 88% were not advantaged or disadvantaged by more than 5%; none were advantaged or disadvantaged by more than 10%. A three scale capitation fee for the age groups 0-64, 65-74, and 75 or over should be applied in the ratio of 3:5:7 rather than in the present ratio of 3:4:5, but given the present population mix in practices there is no case for differential capitation fees by sex or differential fees for the age group 0-4 years.

Adolescent↗
PubMed1987

Capitation payment and mental health care: a review of the opportunities and risks.

Capitation as a method of health care reimbursement has grown dramatically during the past two decades and may have a marked impact on funding for mental health services in coming years. The author defines capitation within the context of various health care reimbursement approaches, presents arguments for and against capitation, reviews the record of capitation for general medical care, and discusses proposals for capitation systems for high-risk patient groups. The potential benefits and risks of capitating mental health services for the general population and for high-risk groups are explored, and initial activities to develop a capitation system for chronic patients in two New York counties are described.

Capitation Fee↗
PubMed1998

Outcome for people with schizophrenia before and after Medicaid capitation at a community agency in Colorado.

OBJECTIVE: To investigate the effect of a capitated funding mechanism for the psychiatric care of Medicaid recipients, a study of outcome, satisfaction, and service utilization among adults with schizophrenia and schizoaffective disorder was conducted at a Colorado agency before and after the introduction of the new funding mechanism. METHODS: Two random samples of 100 clients each were selected, one a year before capitation was introduced and one a year after. Subjects were interviewed about their quality of life, needs, and service satisfaction. Psychopathology and service utilization were also measured. RESULTS: Psychopathology was lower after capitation in most dimensions. The number of subjects admitted to the hospital during a six-month period beginning a year after capitation was 57 percent lower than in the equivalent period before capitation, with no increase in the amount of outpatient treatment provided. Subjects reported improved quality of life in the domains of work, finances, and social relations. Significant changes in needs or service satisfaction were not detected. CONCLUSIONS: No evidence was found that Medicaid capitation had an adverse effect on the client population after one year. Findings suggested that capitation led to an efficient use of treatment resources.

Adult↗
PubMed1995

A contemporary perspective on capitated reimbursement for imaging services.

Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.

Capitation Fee↗
PubMed1998

Alternatives to traditional capitation in managed care agreements.

Risk arrangements typically fall into one of three categories: primary care capitation, professional services capitation, and global, or full-risk, capitation. Yet, in light of various disadvantages associated with these three methods, such as high administrative costs and inappropriate levels of risk assumed by providers, many healthcare payers and providers are experimenting with alternative payment plans. These alternatives include contact capitation arrangements, under which specialists receive a capitation payment on a per referral basis; open-access arrangements, under which patients do not need a gatekeeper referral to see specialists; and capitation arrangements with quality and hospital utilization bonuses, under which specialists and primary care physicians receive a capitation payment plus the potential for bonuses based on quality and utilization criteria.

Capitation Fee↗
PubMed1984

Reducing the cost of health care capital.

Although one may ask four financial experts their opinion on the future of the hospital capital market and receive five answers, the blatant need for financial strategic planning is evident. Clearly, the hospital or system with sound financial management will be better positioned to gain and/or maintain an edge in the competitive environment of the health care sector. The trends of the future include hospitals attempting to: Maximize the efficiency of invested capital. Use the expertise of Board members. Use alternative capital sources. Maximize rate of return on investments. Increase productivity. Adjust to changes in reimbursements. Restructure to use optimal financing for capital needs, i.e., using short-term to build up debt capacity if long-term financing is needed in the future. Take advantage of arbitrage (obtain capital and reinvest it until the funds are needed). Delay actual underwriting until funds are to be used. Better management of accounts receivable and accounts payable to avoid short-term financing for cash flow shortfalls. Use for-profit subsidiaries to obtain venture capital by issuing stock. Use product line management. Use leasing to obtain balance sheet advantages. These trends indicate a need for hospital executives to possess a thorough understanding of the capital formation process. In essence, the bottom line is that the short-term viability and long-term survival of a health care organization will greatly depend on the financial expertise of its decision-makers.

Capital Financing↗
PubMed1981

Use and costs under the Iowa capitation drug program.

This article evaluates changes in the use of drug services and the corresponding costs when the conventional fee-for-service system for reimbursement of pharmacists under medicaid is replaced by a capitation system. The fee-for-service system usually covers ingredient costs plus a fixed professional dispensing fee. The capitation system provided a cash payment (which varied by aid category and season of the year) per Medicaid eligible the first of each month. We examined drug use and costs in two experimental rural counties during a 1-year preperiod in which the fee-for-service form of reimbursement was employed, as well as a 2-year postperiod in which the capitation system was used. We compared the results with use and cost patients in two other rural counties which remained on the fee-for-service system during the same 3-year period. Drug use was similar among control and experimental counties with the exception of nursing home patients; use in this category decreased under capitation and increased under fee-for-service. Using three measures of drug cost: 1) average cost of a day's drug therapy; 2) average drug costs per recipient; and 3) average Medicaid expenditures for drug services per recipient, we observed significant savings under the capitation reimbursement system as compared to the fee-for-service system. We attributed savings under capitation to shifts in prescribing and dispensing behavior, as well as changes in use by nursing home patients. Based upon these findings, the total savings resulting from implementing capitation would be approximately 16 percent compared to fee-for-service reimbursement.

Capitation Fee↗
PubMed1996

Quality assurance in capitated physician groups. Where is the emphasis?

OBJECTIVE: To describe quality assurance (QA) programs implemented by capitated physician groups; to measure their relative emphasis on monitoring of overuse compared with underuse and monitoring and improving preventive services compared with chronic disease care; and to examine how group characteristics influence QA activity. DESIGN: Cross-sectional questionnaire. SETTING: A large network-model health maintenance organization in California (133 contracting physician groups). PARTICIPANTS: Ninety-four physician groups (71%) caring for 2.9 million capitated patients. MAIN OUTCOME MEASURES: Self-reported use of quality monitoring and improvement methods. RESULTS: All capitated physician groups conducted some QA. Groups' QA programs monitored areas subject to overuse, such as cesarean delivery and angioplasty rates, more than areas subject to underuse, such as childhood immunization rates and performance of retinal examinations for diabetic patients (64% vs 43%, P<.001). They monitored underuse of preventive services more than follow-up services for chronic diseases (54% vs 31%, P<.001). Groups also used reminders for preventive services more than they monitored follow-up services for chronic diseases (26% vs 15%, P<.01). Physician group characteristics independently associated with higher overall QA activity were greater number of years in existence, higher profitability, and capitated care penetration. CONCLUSION: Capitation places a large share of responsibility for QA in the hands of physician groups, but not all aspects of QA are being equally addressed. The emphasis on overuse may result from financial incentives inherent in capitation, while the focus on preventive services may stem from lack of adequate quality measurement tools for monitoring chronic disease care. Further research efforts should address how capitated physician groups might expand their QA programs to include monitoring of underuse, especially for patients with chronic disease.

California↗
PubMed1986

Ultrastructure of capitate projections in the optic neuropil of Diptera.

Photoreceptor axons in the first optic neuropil of the dipteran flies Musca domestica and Drosophila melanogaster was examined with electron microscopy. The objective was to determine ultrastructure, persistence and glial source of the capitate projections found within these neurons. Capitate projections are simple or compound processes of epithelial glial cells which profusely insert into form-fitting folds of axon terminals of the peripheral retinular cells (R1-6) in the synaptic plexus portion of the first optic neuropil. These neuro-glial junctions may be simple indentations, have a head with a single stalk, or possess a single, circular stalk from which 3 or 4 bulbous (glial) heads are elaborated. Using serial thick sections of Drosophila neuropil for HVEM we were able to observe that the stalks connecting nearly all capitate projections led directly to a glial cell. Thus no disembodied heads were found suspended in axoplasm. Capitate projections appeared to be persistent structures, present in young as well as senescent adults. No evolution of form was found; thus 3 distinct expressions of these glial processes (without transitional forms) are present. From freeze-fracture replicas and serial HVEM sections it was determined that there were approximately 3 capitate projections per micron 2 in Drosophila and Musca, respectively. About 800 capitate projections exist per Musca axon terminal or about 5 times the number of chemical synapses. Cp's were slightly larger in Drosophila than in Musca, although the Musca retinular axon has twice the diameter and length of that of the fruit fly. The evidence was reviewed in light of the likely supportive function of capitate projections on the R1-6 terminals.

Animals↗
PubMed2002

Nonunion of the isolated capitate waist fracture.

We report a patient with nonunion of an isolated fracture of the capitate. A male 17-year-old high school student directly hit the dorsal aspect of the carpal with the wrist in flexion position against another player's shoulder during a rugby football game. Radiographs did not show a fracture of the capitate on the day after the injury, but nonunion was distinct across the waist at the middle one-third of the capitate 4 months later. The fixation using two cannulated Herbert-Whipple screws with iliac cancellous bone graft led to sound union of the capitate and the patient's ability to return to sporting activities. Although the initial plain radiographs do not show a fracture of the capitate, we should consider the capitate fracture and check the patient by repeated physical examinations and radiographs if the patient suffers from persistent localized pain and tenderness over the capitate.

Adolescent↗
PubMed2006

The protective value of social capital against teen pregnancy: a state-level analysis.

PURPOSE: To investigate whether social capital may explain differences in teen pregnancy rates in the contiguous United States. METHOD: State-level correlational analyses were conducted. Predictor variables included social capital, income inequality, and poverty. MAIN OUTCOME MEASURE: State-level rates of pregnancy for girls 15-19 years old. RESULTS: In bivariate analyses, social capital was inversely correlated with teen pregnancy rates. The obtained correlation was strong (r = -.78) and achieved significance (p < .001). Poverty and income inequality were also significantly correlated with teen pregnancy rates, but the magnitude of these correlations was lower. In a linear regression model, poverty failed to retain significance; however, income inequality achieved significance and produced a Beta value of .24 (p = .017). Social capital was nonetheless a much stronger multivariate predictor of teen pregnancy rates (producing a Beta value of -.672). CONCLUSION: Findings from this state-level analysis suggest that social capital may explain differences between states with respect to teen pregnancy rates. Thus, social capital may play an important role in the prevention of teen pregnancy. This initial finding warrants subsequent empirical investigations designed to identify strategies that can be employed to foster the creation of social capital in communities and entire states.

Adolescent↗
PubMed2004

Mental health and social capital in Cali, Colombia.

Mental ill health forms an increasingly significant part of the burden of disease in developing countries. The growing interest in social risk factors for mental health coincides with the development of social capital research which may further inform the social model of mental health. The objective of the study reported here was to discover if there is an independent association between social capital and mental health when taking into account an array of demographic and violence variables. A total of 1168 youth (15-25 years) in a low income community in Cali, Colombia were surveyed. Mental health was measured by a 20 item self-report questionnaire. The instrument used to measure social capital covered structural and cognitive social capital. Twenty-four per cent of the sample were probable cases of mental ill health. Females had a prevalence rate three times higher than males. Using a model which considered demographic and social capital measures as potential risk factors for mental ill health, the significant risk factors emerged as being female, having limited schooling, working in the informal sector, being a migrant, and having low trust in people. The 'classic' poverty type variables (poor education and employment) were more important than social capital, as was the commonly dominant risk factor for mental ill health-being a woman. When violence factors were added to the model, the 'trust' factor fell out and the most important risk factors became (in descending order of importance): being female; no schooling/incomplete primary; and being a victim of violence. The dominance of poverty related factors, as opposed to social capital, prompts renewed attention to the explanatory mechanisms that link income inequality and poor mental health.

Adolescent↗
PubMed2004

Social capital, the miniaturisation of community and self-reported global and psychological health.

Social capital is often operationalised as social participation in the activities of the formal and informal networks of civil society and/or as generalised trust. Social participation and trust are two aspects of social capital that mutually affect each other, according to the literature. In recent years there has been an increased attention to the fact that generalised trust decreases for every new birth cohort that reaches adulthood in the USA, while social participation may take new forms such as ideologically much narrower single-issue movements that do not enhance trust. The phenomenon has been called "the miniaturisation of community". The effects of similar patterns in Sweden on self-reported health and self-reported psychological health are analysed. The odds ratios of bad self-reported global health are highest in the low-social capital category (low-social participation/low trust), but the miniaturisation of community and low-social participation/high-trust categories also have significantly higher odds ratios than the high-social capital category (high-social participation/high trust). The odds ratios of bad self-reported psychological health are significantly higher in both the low-social capital category and the miniaturisation of community category compared to the high-social capital category, while the low-social participation/high-trust category does not differ from the high-social capital reference group.

Adult↗
PubMed2005

Low linking social capital as a predictor of coronary heart disease in Sweden: a cohort study of 2.8 million people.

This study investigated the association between the recently minted concept of linking social capital and incidence of coronary heart disease (CHD). A follow-up study of 1,358,932 men and 1,446,747 women in Sweden aged 45-74 years was conducted between 1 January 1998 and 31 December 1999. Neighbourhood linking social capital was conceptualised as proportions of individuals voting in local government elections at neighbourhood level. The neighbourhood- and individual-level factors were analysed within a multilevel framework. Linking social capital was associated with CHD in both men and women beyond individual-level factors: in neighbourhoods with low linking social capital the odds ratios were 1.19 (CI = 1.14-1.24) and 1.29 (CI = 1.21-1.38) for men and women, respectively, after adjustment for age, country of birth, education, marital status, and housing tenure. The significant between-neighbourhood variance (i.e. the random intercept) showed significant differences in CHD incidence between neighbourhoods. Even in a relatively egalitarian society, as exemplified by the Swedish Welfare State, individual health is affected by differences between neighbourhoods in linking social capital. The use of linking social capital represents a novel conceptual advance in research on the association between CHD, one of the major causes of death in Western countries, and the multidimensional aspects of social capital.

Aged↗
PubMed2000

Social capital and health promotion: a review.

Interest in social capital and health has emerged at an exciting time. In public health, there is a renewed interest in mechanisms that link social inequalities and health. In epidemiology, there has been a critical interrogation of methods and a call for a more explicit use of theory. In health promotion over the last 20-30 years, social health interventions have been somewhat marginalised in an era dominated by interest in traditional cardiovascular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in social health promotion and the literatures that have informed it could be overlooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequality and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes thought to underlie this relationship. Social capital has relational, material and political aspects. We suggest that, although the relational properties of social capital are important (eg, trust, networks), the political aspects of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operationalised by social theorists and intervention agents in other fields. We suggest that social capital research so far has inadequately captured the underlying constructs, in particular the qualitative difference between the macro/context level and the micro/individual level. While being cautious about the science, we conclude that social capital's power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence of interests in context-level influences on health now invites a revitalisation of theories and interventions inspired by diverse fields, such as geography and ecological community psychology.

Canada↗
PubMedDate not supplied

Natural capital in ecology and economics: an overview.

The Brundtland Commission report, Our Common Future, defined sustainable development as development that meets the needs of the present without compromising the ability of future generations to meet their own needs. Although the idea of sustainable development has been widely accepted, it has proved difficult to identify and implement policies and practices that promote sustainable economic growth. Some economists, environmental scientists and policy analysts believe that they can transform the consensus about sustainability into manageable practices. They propose to accomplish this feat with a set of new ideas about the relationships between the economy and the environment offered under the banner of 'natural capital'. An ideal account of natural capital would be one or more standard measures or models that would allow the direct comparison of environmental goods, like forests, fresh water and clean air, with economic goods, like money, capital and productivity. By bringing economic science and environmental science to an objective common ground, a natural capital model has the potential to provide a concrete means of comparing the economic and ecological costs and benefits of particular policies and programmes. This paper offers a survey and analysis of several new contributions to the formation of the natural capital concept from economists, ecologists, policy analysts, biometricians, foresters and a philosopher. The paper concludes that existing microeconomic theory may be 'ungreenable', if it is not reformulated. While macroeconomic approaches to natural capital have beenmore successful, they share the limitation that ecosystems and species are valued solely in monetary terms. These problems are taken to suggest that the development of a successful natural capital model may require economic theory to be recast to include non-monetary social preferences and values.

Conservation of Natural Resources↗