Rate adjusters for Medicare under capitation
Health Care Financ Rev.
1986.
Abstract
This article addresses three issues related to capitation. First, the average adjusted per capita cost (AAPCC) fluctuates with the mix of risks in the fee-for-service system. More sensitive adjusters in the AAPCC are needed. Second, the AAPCC, as now estimated, exhibits large geographic variance; so-called shrinkage estimators may help. Third, the AAPCC requires new adjusters to yield more homogeneous risk classes. Otherwise, the portion of the Medicare population under capitation may experience access problems at alternative delivery systems. Until such adjusters are developed, it seems better to rely upon a blend of capitation and fee-for-service than the present AAPCC.
Similar articles
-
Using chronic disease risk factors to adjust Medicare capitation payments.Health Care Financ Rev. 1992 Fall;14(1):79-90. Health Care Financ Rev. 1992. PMID: 10124441 Free PMC article.
-
Pricing strategies for capitated delivery systems.Health Care Financ Rev. 1986;1986(Spec No):35-44. Health Care Financ Rev. 1986. PMID: 10311925 Free PMC article.
-
Payment to health maintenance organizations and the geographic factor.Health Care Financ Rev. 1990 Fall;12(1):19-30. Health Care Financ Rev. 1990. PMID: 10113459 Free PMC article.
-
Risk-based capitation payments for health care: a survey of the literature.J Health Adm Educ. 1987 Fall;5(4):571-93. J Health Adm Educ. 1987. PMID: 10312284 Review.
-
Risk adjustment for a children's capitation rate.Health Care Financ Rev. 1993 Fall;15(1):39-54. Health Care Financ Rev. 1993. PMID: 10133708 Free PMC article. Review.
Cited by
-
Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information.Health Serv Res. 1999 Feb;33(6):1727-44. Health Serv Res. 1999. PMID: 10029506 Free PMC article.
-
Attempt at deriving a formula for setting general practitioner fundholding budgets.BMJ. 1994 Oct 22;309(6961):1059-64. doi: 10.1136/bmj.309.6961.1059. BMJ. 1994. PMID: 7950741 Free PMC article.
-
Diagnosis-based risk adjustment for Medicare capitation payments.Health Care Financ Rev. 1996 Spring;17(3):101-28. Health Care Financ Rev. 1996. PMID: 10172666 Free PMC article.
-
Contract design for primary care physicians: physician location and practice behaviour in small communities.Health Care Manag Sci. 2000 Feb;3(2):151-7. doi: 10.1023/a:1019041307532. Health Care Manag Sci. 2000. PMID: 10780283
-
Improving the AAPCC (adjusted average per capita cost) with health-status measures from the MCBS (Medicare Current Beneficiary Survey).Health Care Financ Rev. 1996 Spring;17(3):59-75. Health Care Financ Rev. 1996. PMID: 10158736 Free PMC article.
References
-
- Anderson G, Knickman J. Patterns of expenditure among high utilizers of medical care services: The experience of Medicare beneficiaries from 1974 to 1977. Med Care. 1984a Feb.222:143–149. - PubMed
-
- Anderson G, Knickman J. Adverse selection under a voucher system: Grouping Medicare recipients by level of expenditure. Inquiry. 1984b Summer;212:135–143. - PubMed
-
- Anderson J, Gertman P. AAPCC Technical Note No.5. Health Policy Center, Heller Graduate School, Brandeis University; 1983. Monitoring of HMO enrollment practices. cited in Lubitz, Beebe, and Riley, 1985.
-
- Beebe J, Lubitz J, Eggers P. Office of Research and Demonstrations, Health Care Financing Administration. Health Care Financing Review. 3. Vol. 6. Washington: U.S. Government Printing Office; Spring. 1985. Using prior utilization to determine payments of Medicare enrollees in health maintenance organizations. HCFA Pub. No. 03198. - PMC - PubMed
-
- Buchanan J, Cretin S. Fee-for-Service Health Care Expenditures: Evidence of Selection Effects Among Subscribers Who Choose HMO's. Santa Monica, Calif.: Rand Corporation; 1986. Publication No R-3341-HHS. Prepared for Department of Health and Human Services.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical