capitation fee

Summary

Summary: A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.

Top Publications

  1. ncbi An examination of factors in the withdrawal of managed care plans from the Medicare+Choice program
    Mitchell P V Glavin
    Schneider Institute for Health Policy, Brandeis University, Waltham, MA 02454, USA
    Inquiry 39:341-54. 2002
  2. pmc Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation
    Richard H Glazier
    Institute for Clinical Evaluative Sciences, Toronto, Ont
    CMAJ 180:E72-81. 2009
  3. pmc Understanding biased selection in Medicare HMOs
    Michelle M Mello
    Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA
    Health Serv Res 38:961-92. 2003
  4. ncbi Financial incentives influencing the integration of mental health care and primary care
    R J Goldberg
    Brown University, Rhode Island Hospital, Providence 02903, USA
    Psychiatr Serv 50:1071-5. 1999
  5. ncbi Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care management
    John S Hughes
    Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
    Med Care 42:81-90. 2004
  6. ncbi Variation in outpatient mental health service utilization under capitation
    Ann F Chou
    Health Services and Research Development, Richard L Roudebush VA Medical Center, and Indiana University Purdue University, 801 W Michigan St, Indianapolis, IN 46202, USA
    J Ment Health Policy Econ 8:3-14. 2005
  7. pmc Principal inpatient diagnostic cost group model for Medicare risk adjustment
    G C Pope
    Health Economics Research, Inc, Waltham, MA 02452, USA
    Health Care Financ Rev 21:93-118. 2000
  8. ncbi Methods of reducing the financial risk of physicians under capitation
    G F Anderson
    Johns Hopkins Center for Hospital Finance and Management, Baltimore, MD, USA
    Arch Fam Med 8:149-55. 1999
  9. pmc Implementation of risk adjustment for Medicare
    M J Ingber
    Office of Strategic Planning, Health Care Financing Administration, Baltimore, MD 21244 1850, USA
    Health Care Financ Rev 21:119-26. 2000
  10. pmc Improving health-based payment for Medicaid beneficiaries: CDPS
    R Kronick
    Department of Family and Preventive Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 0622, USA
    Health Care Financ Rev 21:29-64. 2000

Detail Information

Publications165 found, 100 shown here

  1. ncbi An examination of factors in the withdrawal of managed care plans from the Medicare+Choice program
    Mitchell P V Glavin
    Schneider Institute for Health Policy, Brandeis University, Waltham, MA 02454, USA
    Inquiry 39:341-54. 2002
    ..The findings suggest HMO participation in Medicare+Choice will continue to fall unless major changes are made to the overall Medicare program and the method of paying HMOs...
  2. pmc Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation
    Richard H Glazier
    Institute for Clinical Evaluative Sciences, Toronto, Ont
    CMAJ 180:E72-81. 2009
    ..Both models involve patient rostering, incentives for preventive care and requirements for after-hours care. We evaluated practice characteristics and patterns of care under both models...
  3. pmc Understanding biased selection in Medicare HMOs
    Michelle M Mello
    Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA
    Health Serv Res 38:961-92. 2003
    ....
  4. ncbi Financial incentives influencing the integration of mental health care and primary care
    R J Goldberg
    Brown University, Rhode Island Hospital, Providence 02903, USA
    Psychiatr Serv 50:1071-5. 1999
    ..This model increases motivation to lower overall utilization of care, improve patients' overall health status, and search for more effective models of care...
  5. ncbi Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care management
    John S Hughes
    Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
    Med Care 42:81-90. 2004
    ....
  6. ncbi Variation in outpatient mental health service utilization under capitation
    Ann F Chou
    Health Services and Research Development, Richard L Roudebush VA Medical Center, and Indiana University Purdue University, 801 W Michigan St, Indianapolis, IN 46202, USA
    J Ment Health Policy Econ 8:3-14. 2005
    ..Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services...
  7. pmc Principal inpatient diagnostic cost group model for Medicare risk adjustment
    G C Pope
    Health Economics Research, Inc, Waltham, MA 02452, USA
    Health Care Financ Rev 21:93-118. 2000
    ..In this article, the authors describe the risk-adjustment model HCFA is implementing in the year 2000, known as the Principal Inpatient Diagnostic Cost Group (PIPDCG) model...
  8. ncbi Methods of reducing the financial risk of physicians under capitation
    G F Anderson
    Johns Hopkins Center for Hospital Finance and Management, Baltimore, MD, USA
    Arch Fam Med 8:149-55. 1999
    ..We conclude with a discussion of 3 methods for reducing or limiting risk--reinsurance, "carve outs," and risk adjustment...
  9. pmc Implementation of risk adjustment for Medicare
    M J Ingber
    Office of Strategic Planning, Health Care Financing Administration, Baltimore, MD 21244 1850, USA
    Health Care Financ Rev 21:119-26. 2000
    ....
  10. pmc Improving health-based payment for Medicaid beneficiaries: CDPS
    R Kronick
    Department of Family and Preventive Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 0622, USA
    Health Care Financ Rev 21:29-64. 2000
    ..The authors also compare the taxonomy and statistical performance of CDPS to other leading diagnostic classification systems and find that the new model performs better in a number of respects...
  11. ncbi Issues regarding health plan payments under Medicare and recommendations for reform
    B Dowd
    School of Public Health, Division of Health Services Research and Policy, University of Minnesota, Minneapolis 55455 0392
    Milbank Q 70:423-53. 1992
    ..Lacking payment reforms, the Medicare HMO program should be terminated...
  12. ncbi Consolidation of medical groups into physician practice management organizations
    J C Robinson
    School of Public Health, University of California, Berkeley 94720, USA
    JAMA 279:144-9. 1998
    ..These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans...
  13. ncbi How do doctors behave when some (but not all) of their patients are in managed care?
    Sherry Glied
    Department of Health Policy and Management, Joseph Mailman School of Public Health, Columbia University, New York, NY 10032, USA
    J Health Econ 21:337-53. 2002
    ..Practice composition has strong effects on treatment. Visit duration appears to be constant across patients within a practice, while medications prescribed appear to be converging as managed care penetration increases...
  14. ncbi The effect of practitioner compensation on HMO consumer satisfaction
    John F Scoggins
    Manag Care 11:49-52. 2002
    ..To test the hypothesis that a health maintenance organization (HMO) consumer's satisfaction depends on the way his or her health plan compensates practitioners...
  15. ncbi How profitable is risk selection? A comparison of four risk adjustment models
    Yujing Shen
    Department of Health Services, Boston University School of Public Health, USA
    Health Econ 11:165-74. 2002
    ..The magnitude of potential profit varies according to the risk adjustment model and the private information plans can employ to identify profitable enrollees...
  16. ncbi Service-level selection by HMOs in Medicare
    Zhun Cao
    Center for Multicultural Mental Health Research, Cambridge Health Alliance, 120 Beacon Street, 4th Floor, Somerville, MA 02143, USA
    J Health Econ 22:915-31. 2003
    ..We find evidence indicating that there exists significant service-level selection by HMOs...
  17. ncbi The impact of managed care on the use of outpatient mental health and substance abuse services in Puerto Rico
    M Alegria
    Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan 00936 5067, USA
    Inquiry 38:381-95. 2001
    ..Neither forecast turned out to be correct. The question remains as to how to improve access for the poor with low capitation rates...
  18. ncbi Service use and health status of persons with severe mental illness in full-risk and no-risk medicaid programs
    Joseph P Morrissey
    Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 27599 7590, USA
    Psychiatr Serv 53:293-8. 2002
    ....
  19. ncbi Availability of nutrition services for Medicaid recipients in the northeastern United States: lack of uniformity and the positive effect of managed care
    Adam Gilden Tsai
    Division of General Internal Medicine, 1125 Blockley Hall, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA
    Am J Manag Care 9:817-21. 2003
    ....
  20. pmc The costs of decedents in the Medicare program: implications for payments to Medicare + Choice plans
    Melinda Beeuwkes Buntin
    RAND Health, Arlington, VA 22202, USA
    Health Serv Res 39:111-30. 2004
    ....
  21. ncbi The predictability of individual primary care costs and its impact on managed care plans
    Marie Demers
    Ministère de la Santé et des Services sociaux, 1005 Chemin Sainte Foy, 5e Etage, Quebec, Que, Canada G1S 4N4
    Health Policy 68:345-52. 2004
    ..The stability of individual costs of care in family practices illustrated by the high transition probabilities over time indicates the possibility to forecast these costs in a perspective of capitation payment plans...
  22. ncbi Cost-minimizing risk adjustment
    Yujing Shen
    Center for Health Quality, Outcomes and Economic Research, Boston University School of Public Health, Bedford, MA 01730, USA
    J Health Econ 21:515-30. 2002
    ..Estimations using privately-insured data suggest that cost-minimizing risk adjusted premiums reduce total sponsor costs as much as 25.6% below conventional risk adjustment premiums...
  23. ncbi Service production and contract choice in primary physician services
    Rune J Sørensen
    Norwegian School of Management BI, University of Oslo, P O Box 580, N 1301 Sandvika, Norway
    Health Policy 66:73-93. 2003
    ..When these and other effects are taken into account, we find that a change from a salary contract to a fee-for-service contract will increase service production by 20-40%...
  24. pmc Two-year outcomes of fee-for-service and capitated medicaid programs for people with severe mental illness
    Brian J Cuffel
    United Behavioral Health, San Francisco, CA 94105, USA
    Health Serv Res 37:341-59. 2002
    ..To examine the effects of two models of capitation on the clinical outcomes of Medicaid beneficiaries in the state of Colorado...
  25. ncbi Medicaid managed care payment methods and capitation rates in 2001
    John Holahan
    Health Policy Research Center, Urban Institute, Washington, DC, USA
    Health Aff (Millwood) 22:204-18. 2003
    ..The data also show that the growth in Medicaid capitation rates between 1998 and 2001 averaged 18 percent, considerably more than the increase in Medicare+Choice rates...
  26. ncbi Evaluating risk: global fees and episodic care
    Doug Emery
    Semmetry Health Data Systems, Inc, Phoenix, Arizona, USA
    Physician Exec 29:36-44. 2003
    ..This follow-up focuses on comparing an episode contracting system to a traditional capitated program and outlines the features that make this approach much more attractive to physicians, payers, and most importantly patients...
  27. ncbi Do adjusted clinical groups eliminate incentives for HMOs to avoid substance abusers? Evidence from the Maryland Medicaid HealthChoice program
    Susan L Ettner
    UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Room 106, Box 951736, Los Angeles, CA 90095 1736, USA
    J Behav Health Serv Res 30:63-77. 2003
    ..Thus, the adjusted clinical groups methodology used to adjust capitation payments in the HealthChoice program attenuated, but did not eliminate, financial incentives for MCOs to avoid substance abusers...
  28. ncbi Has Medicaid managed care affected beneficiary access and use?
    Stephen Zuckerman
    Health Policy Center, Urban Institute, Washington, DC 20037, USA
    Inquiry 39:221-42. 2002
    ..With the exception of mandatory HMO programs, discrepancies in access and use continue to exist between Medicaid managed care enrollees and low-income privately insured people...
  29. ncbi Evaluating selection out of health plans for Medicaid beneficiaries with substance abuse
    Sharon Lise T Normand
    Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
    J Behav Health Serv Res 30:78-92. 2003
    ..These results suggest that current risk-adjustment systems may fail to offset selection incentives in modern capitated health plans...
  30. pmc Provision of sexual health services to adolescent enrollees in Medicaid managed care
    William E Lafferty
    Department of Health Services, University of Washington, Seattle 98195, USA
    Am J Public Health 92:1779-83. 2002
    ..This Seattle project measured sexual health services provided to 1112 Medicaid managed care enrollees aged 14 to 18 years...
  31. ncbi Insurance product design and its effects: trade-offs along the managed care continuum
    Peter Kemper
    Department of Health Policy and Administration, Pennsylvania State University, University Park 16802 6500, USA
    Inquiry 39:101-17. 2002
    ....
  32. ncbi Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients
    Steve Berman
    Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
    Pediatrics 110:239-48. 2002
    ....
  33. ncbi Biased enrollment of Medicare beneficiaries in HMO plans--implications for Medicare costs
    M Mahmud Khan
    Department of Health System Management, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
    J Health Care Finance 28:43-57. 2002
    ..The probability of not enrolling high-loss cases is found to be high, indicating that the biased selection in HMO plans actually increases the overall cost of running the Medicare program...
  34. ncbi Strategies for integrating Medicare and Medicaid: design features and incentives
    Edward Alan Miller
    University of Michigan, USA
    Med Care Res Rev 60:123-57. 2003
    ..Future efforts would be well served by carefully considering the incentive structures designed into these initiatives and working to improve them in the next generation of Medicare-Medicaid integration efforts...
  35. ncbi The coming third health care revolution: personal empowerment
    Duncan Neuhauser
    Case Western Reserve University, Department of Epidemiology and Biostatistics, Cleveland, Ohio, USA
    Qual Manag Health Care 12:171-84; discussion 185-6. 2003
    ..It is proposed that a third revolution, patient empowerment, is just starting. The potential far-reaching consequences are described, discussed, and analyzed here, including their cost consequences...
  36. ncbi Medicare's risk-adjusted capitation method
    Paul L Grimaldi
    State Healthcare Division of Affiliated Computer Services, Inc, Rockville, MD, USA
    J Health Care Finance 28:105-19. 2002
    ..These changes were expected to increase the number of participating health plans, accelerate Medicare enrollment growth, and slice Medicare spending...
  37. ncbi Do welfare caseload declines make the Medicaid risk pool sicker?
    Bowen Garrett
    Health Policy Center of the Urban Institute, Washington, DC 20037, USA
    Inquiry 39:12-33. 2002
    ..We adjust utilization differences for insurance status and factors often used to adjust capitation rates. We conclude that declining welfare caseloads likely will result in a sicker and more expensive adult Medicaid risk pool...
  38. ncbi Group practice contracting with managed care: Part 2
    Lewis W Mustard
    Healthcare Negligence Control, Inc, P O Box 2442, Chapel Hill, NC 27515, USA
    J Med Pract Manage 19:45-9. 2003
    ..This article (the second in the series) provides a framework for administrators and practices to consider when approaching negotiations for such contracts...
  39. ncbi Do children receiving Supplemental Security Income who are enrolled in Medicaid fare better under a fee-for-service or comprehensive capitation model?
    Jean M Mitchell
    Georgetown Public Policy Institute, Georgetown University, Washington, District of Columbia 20007, USA
    Pediatrics 114:196-204. 2004
    ..Little research has examined how children with SHCN who qualify for Supplemental Security Income (SSI) fare under managed care versus the fee-for-service (FFS) system...
  40. pmc Risk adjustment alternatives in paying for behavioral health care under Medicaid
    S L Ettner
    UCLA Department of Medicine, Los Angeles, CA 90095-1736, USA
    Health Serv Res 36:793-811. 2001
    ..CONCLUSIONS: Current risk adjustment methodologies do not eliminate the financial incentives for integrated health plans and behavioral health care carve-out plans to avoid high-utilizing patients with psychiatric disorders...
  41. pmc Economic efficiency of gate-keeping compared with fee for service plans: a Swiss example
    Matthias Schwenkglenks
    ECPM Research, c o ECPM Executive Office, University Hospital, CH 4031 Basle, Switzerland
    J Epidemiol Community Health 60:24-30. 2006
    ..The aim of this study was to assess to what extent lower costs in a gate-keeping plan compared with a fee for service plan were attributable to more efficient resource management, or explained by risk selection...
  42. ncbi The implementation of managed behavioral healthcare in Colorado and the effects on older Medicaid beneficiaries
    Brian Kaskie
    Department of Health Management and Policy, The University of Iowa, 200 Hawkins Drive, E206 GH, Iowa City, IA 52242, USA
    J Ment Health Policy Econ 9:15-24. 2006
    ..The Colorado Medicaid Mental Health Capitation Pilot Program, implemented in 1995, provided an opportunity to investigate the impact of managed behavioral healthcare on older Medicaid beneficiaries...
  43. ncbi Predicting future healthcare costs: how well does risk-adjustment work?
    Michael A Cucciare
    Department of Psychology, University of Nevada, Reno, Nevada, USA
    J Health Organ Manag 20:150-62. 2006
    ..This can have the consequence of reducing overpayments and incentives to under treat or reject high cost individuals. This paper seeks to review recent studies presenting risk-adjustment models...
  44. ncbi Non-face-to-face services deserve HMO coverage too
    Michael S Victoroff
    Manag Care 12:13-6. 2003
  45. pmc Partially capitated managed care versus FFS for special needs children
    Cynthia R Schuster
    THE RAND CORPORATION, USA
    Health Care Financ Rev 28:109-23. 2007
    ..We attribute much of these disparities in use of therapeutic services at school to the availability of case management and coordination that is an integral component of the partially capitated MCP...
  46. ncbi Level the playing field. It is time to end the advantage of Medicare managed care
    Todd Sloane
    Mod Healthc 37:22. 2007
  47. ncbi Advantage cuts possible. Wyden wants regional data to rule on Medicare plan
    Jennifer Lubell
    Mod Healthc 37:8-9. 2007
  48. ncbi Quality of drug treatment of childhood persistent asthma in Maryland medicaid recipients in transition from managed fee for service to managed capitation
    Puneet K Singhal
    University of Maryland at Baltimore, School of Pharmacy, USA
    J Manag Care Pharm 13:310-8. 2007
    ..Although research has been conducted on the quality of asthma care among MCOs and in MCOs for Medicaid versus non-Medicaid members, the quality of asthma care has been less well studied for MCO patients than for FFS patients...
  49. ncbi Caregivers' ratings of access: do children with special health care needs fare better under fee-for-service or partially capitated managed care?
    Jean M Mitchell
    Georgetown Public Policy Institute, Washington, DC, USA
    Med Care 45:146-53. 2007
    ....
  50. pmc Outcomes for medicaid clients with substance abuse problems before and after managed care
    Bentson H McFarland
    RMC Research Corporation, Portland, Ore, USA
    J Behav Health Serv Res 32:351-67. 2005
    ..On the other hand, state policies influencing Medicaid enrollment may have substantial impact on chemical dependency treatment outcomes...
  51. pmc The alignment and blending of payment incentives within physician organizations
    James C Robinson
    University of California, Berkeley, School of Public Health, 140 Warren, Berkeley, CA 94720 7360, USA
    Health Serv Res 39:1589-606. 2004
    ....
  52. ncbi Capitated Medicaid managed care in a rural area: the impact of Minnesota's PMAP program
    Sharon K Long
    Health Policy Center, The Urban Institute, Washington, DC 20037, USA
    J Rural Health 21:12-20. 2005
    ..As such, understanding the effects of capitated MMC in rural settings is important for policy considerations...
  53. ncbi Medicare HMO impact on utilization at the end of life
    Kateryna Fonkych
    RAND Health Pro gram, 1776 Main St, PO Box 2138, Santa Monica, CA 90407 2138, USA
    Am J Manag Care 14:505-12. 2008
    ....
  54. ncbi Docs vs. insurers. AMA spars with AHIP over Medicare Advantage
    Matthew DoBias
    Mod Healthc 37:12. 2007
  55. ncbi Children with special health care needs and managed care
    Diana Obrinsky
    Pediatrics 116:520-1. 2005
  56. pmc Factors affecting plan choice and unmet need among supplemental security income eligible children with disabilities
    Jean M Mitchell
    Georgetown Public Policy Institute, 3520 Prospect St NW, Room 423, Washington, DC 20007, USA
    Health Serv Res 40:1379-99. 2005
    ....
  57. pmc Evaluating health care programs by combining cost with quality of life measures: a case study comparing capitation and fee for service
    Richard Grieve
    Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E7HT, UK
    Health Serv Res 43:1204-22. 2008
    ..To demonstrate cost-effectiveness analysis (CEA) for evaluating different reimbursement models...
  58. ncbi The Danish health system through an American lens
    Karen Davis
    The Commonwealth Fund, One East 75th Street, New York, NY 10021, USA
    Health Policy 59:119-32. 2002
    ..While innovations in electronic prescribing are noteworthy, further development of health information technology is needed...
  59. ncbi [Towards Unity for Health" criteria applied to medical centers in Belgium]
    Pierre Drielsma
    Fédération des maisons médicales, Bruxelles, Belgium
    Educ Health (Abingdon) 20:104. 2007
    ..To describe the Belgian medical centers' experience against TUFH criteria. To identify convergences, strengths and weaknesses, and suggest explanations. To present current dynamics in medical centers...
  60. ncbi The effects of a patient shortage on general practitioners' future income and list of patients
    Tor Iversen
    Health Economics Research Programme of Oslo HERO, Center for Health Administration, NO 0027 Oslo, Norway
    J Health Econ 23:673-94. 2004
    ..The payment system is a mix of a capitation fee and a fee for service. The data set has information on patient shortage, i.e...
  61. ncbi Changes in the remuneration system for general practitioners: effects on contact type and consultation length
    Christel E van Dijk
    NIVEL, Netherlands Institute for Health Services Research, P O Box 1568, 3500 BN, Utrecht, The Netherlands
    Eur J Health Econ 15:83-91. 2014
    In The Netherlands, the remuneration system for GPs changed in 2006. Before the change, GPs received a capitation fee for publicly insured patients and fee for service (FFS) for privately insured patients...
  62. ncbi Importing budget systems from other countries: what can we learn from the German drug budget and the British GP fundholding?
    D Delnoij
    NIVEL, PO Box 1568, 3500 BN, Utrecht, The Netherlands
    Health Policy 52:157-69. 2000
    ..For the introduction of fundholding, a number of additional criteria need to be met, such as having gate-keeping GPs with personal lists and having a single-payer system...
  63. pmc Argument for blended funding
    Walter W Rosser
    Can Fam Physician 48:236-7, 247-9. 2002
  64. ncbi How IPAs are changing
    Ken Terry
    Med Econ 80:52, 57-8. 2003
  65. ncbi A field experiment in capitated payment systems and recovery management: the women's recovery association pilot study
    Bryn King
    Women s Recovery Association, University of California, Berkeley, School of Social Welfare, Burlingame and Berkeley, CA 94010, USA
    J Psychoactive Drugs . 2010
    ..Lessons learned and implications for the second year of the pilot project are also discussed...
  66. ncbi A prospective trial of a clinical pharmacy intervention in a primary care practice in a capitated payment system
    Jeanette L Altavela
    Greater Rochester Independent Practice Association, 60 Carlson Road, Rochester, NY 14610, USA
    J Manag Care Pharm 14:831-43. 2008
    ..The few studies that address economic outcomes (a) often report estimated instead of actual medical costs, (b) report only medication costs, or (c) have been conducted in settings that are not typical of community-based primary care...
  67. ncbi Denplan comes of age--a personal view
    P B F Swiss
    Br Dent J 205:475-6. 2008
    ..Celebrating its 21(st) birthday this year, Peter Swiss a former Dental Director of the company, reflects on its pioneering beginnings, its development and the place of capitation plans in dentistry...
  68. ncbi Medicaid chemical dependency patients in a commercial health plan: do high medical costs come down over time?
    Lawrence J Walter
    Division of Research, Oakland, CA 94602, USA
    J Behav Health Serv Res 32:253-63. 2005
    ..These results may help address concerns among Medicaid managed care providers and payers by giving a more realistic account of the long-term costs of this group of high-utilizing enrollees...
  69. ncbi Ethics and incentives: an evaluation and development of stakeholder theory in the health care industry
    Heather Elms
    Bus Ethics Q 12:413-32. 2002
    ..Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering...
  70. ncbi Paying doctors by salary: a controlled study of general practitioner behaviour in England
    Toby Gosden
    National Primary Care Research and Development Centre, 5th Floor Williamson Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
    Health Policy 64:415-23. 2003
    ..However, none of these differences were statistically significant. To conclude, salaried contracts did not adversely affect GP productivity and had little impact on other aspects of GP behaviour or the quality of care provided...
  71. ncbi Paving the way for electronic medical records
    J A Gleiner
    Physician Exec 26:32-6. 2000
    ..Obstacles and benefits to implementing EMR systems are outlined. Despite some of the barriers to implementing EMRs, the future is bright for their widespread deployment...
  72. ncbi Effect of physician reimbursement methodology on the rate and cost of cataract surgery
    William Shrank
    Division of General Internal Medicine, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, Calif, USA
    Arch Ophthalmol 123:1733-8. 2005
    ..Previous research evaluating the relationship between physician reimbursement incentives and cataract surgical rates has been limited by physician and patient selection bias...
  73. ncbi Can an MSO help you?
    Ken Terry
    Med Econ 83:40-2, 44. 2006
  74. ncbi Flawed Medicare formula promotes capitationism
    AppaRao Mukkamala
    Mich Med 106:40. 2007
  75. pmc Expenditures for mental health services in the Utah Prepaid Mental Health Plan
    T Stoner
    School of Public Health, University of Minnesota, USA
    Health Care Financ Rev 18:73-93. 1997
    ..In contrast, the UPMHP had no statistically significant effect on outpatient mental health expenditures or visits. There was no significant effect of the UPMHP on overall mental health expenditures...
  76. ncbi Questions to ask before joining a multispecialty group
    Ken Terry
    Med Econ 79:124-6, 131-4. 2002
  77. ncbi The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care
    A L Hillman
    Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia 19104 6021, USA
    Pediatrics 104:931-5. 1999
    ..We studied whether a system of semiannual assessment and feedback, coupled with financial incentives, could improve pediatric preventive care in a Medicaid health maintenance organization (HMO)...
  78. pmc Modeling Medicare costs of PACE (Program of All-Inclusive Care for the Elderly) populations
    J Robinson
    Center for Health Systems Research and Analysis, University of Wisconsin Madison, USA
    Health Care Financ Rev 21:149-70. 2000
    ..This study revisits the calculation of the PACE frailty adjuster and explores the effect of risk adjustment on that frailty adjuster...
  79. ncbi Capitated contracting roles and relationships in healthcare
    G J Bazzoli
    Northwestern University, Evanston, IL, USA
    J Healthc Manag 45:170-87; discussion 187-8. 2000
    ..The experiences of these organizations provide valuable guidance for health executives as they develop or refine capitated contracting strategies...
  80. ncbi Primary care physicians' approach to depressive disorders. Effects of physician specialty and practice structure
    J W Williams
    Audie Murphy Division, South Texas Veterans Health Care System, San Antonio 78284, USA
    Arch Fam Med 8:58-67. 1999
    ..Despite this opportunity, care for depression is often suboptimal...
  81. ncbi Fewer patient visits under capitation offset by improved quality of care: study brings evidence to debate over physician payment methods
    Catherine V Eikel
    Find Brief 5:1-2. 2002
  82. ncbi Integrating care: a talk with Kaiser Permanente's David Lawrence. Interview by Jeff Goldsmith
    David Lawrence
    Health Aff (Millwood) 21:39-48. 2002
  83. ncbi Strategic health system development and managed care delivery
    Roger C Nauert
    RCN Associates, Houston, TX, USA
    J Health Care Finance 29:5-17. 2002
    ..Their compelling motivation has been fueled by the onslaught of managed care. Successful initiatives have been driven by mutual strategic system planning, effective management, and enhanced quality of care...
  84. ncbi Patient attitudes toward physician financial incentives
    A G Pereira
    Center for Ethics in Managed Care, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA
    Arch Intern Med 161:1313-7. 2001
    ..Discomfort was highest with capitation and was more likely among wealthier, well-educated, white patients. With capitation increasing nationally, patients' concerns should be considered in the design of compensation agreements...
  85. pmc Variation in patient-reported quality among health care organizations
    Loel S Solomon
    Health Care Financ Rev 23:85-100. 2002
    ..There was significant variation among RSOs, groups and sites, with practice sites explaining the greatest share of variation for most measures...
  86. pmc S/HMO versus TEFRA HMO enrollees: analysis of expenditures
    B Dowd
    Division of Health Services Research and Policy, University of Minnesota, 420 Delaware Street SE, Box 729 Mayo, Minneapolis, MN 55455, USA
    Health Care Financ Rev 20:7-23. 1999
    ..There do not appear to be any overall savings associated with S/HMO membership, including any savings from substitution of S/HMO-specific services for other, traditional services covered by both the S/HMO and the TEFRA HMO...
  87. ncbi Institutionalized patients with hip fractures: characteristics associated with returning to community dwelling
    J F Fitzgerald
    Regenstrief Institute for Health Care, Indianapolis, IN 46202
    J Gen Intern Med 5:298-303. 1990
    ..37, 95% CI 0.05, 0.53). These data suggest the existence of patient and nursing home features that identify those institutionalized patients with hip fractures who are more likely to return to community dwelling...
  88. ncbi Risk-sharing: past, present, future
    Dean C Coddington
    Healthc Leadersh Manag Rep 11:1-7, 9. 2003
  89. pmc Resource allocation and purchasing in the health sector: the English experience
    Peter C Smith
    Centre for Health Economics, University of York, England
    Bull World Health Organ 86:884-8. 2008
    ..The English example is relevant to less-developed health systems, especially for those governments seeking to decentralize, to improve accountability and to promote equity...
  90. ncbi Financial systems' impact on dental care; a review of fee-for-service and capitation systems
    V Johansson
    Department of Oral Public Health, Malmo University, Sweden
    Community Dent Health 24:12-20. 2007
    ..This review covers the impact of financial systems on dental care...
  91. ncbi Mode of payment, practice characteristics, and physician support for patient self care
    J H Hibbard
    Department of Planning, Public Policy, and Management, University of Oregon, Eugene, Oregon, USA
    Am J Prev Med 20:118-23. 2001
    ..This study empirically examines this assumption...
  92. ncbi How general practice is funded in The Netherlands
    Chris van Weel
    Department of General Practice, University Medical Centre Nijmegen, The Netherlands
    Med J Aust 181:110-1. 2004
  93. ncbi Overbilling vs. downcoding--the battle between physicians and insurers
    Aaron S Kesselheim
    Brigham and Women s Hospital and Harvard Medical School, Boston, USA
    N Engl J Med 352:855-7. 2005
  94. pmc Primary care capitation payments in the UK. An observational study
    Gwion Rhys
    Ty Doctor, Ffordd Dewi Sant, Nefyn, LL53 6EA, UK
    BMC Health Serv Res 10:156. 2010
    ..Similar pay formulae were introduced in Scotland and Northern Ireland, but these are unique to the country and therefore could not be included in this study...
  95. pmc Access to primary health care for immigrants: results of a patient survey conducted in 137 primary care practices in Ontario, Canada
    Elizabeth Muggah
    CT Lamont Primary Health Care Research Centre, Elisabeth Bruyere Research Institute, Ottawa, ON, Canada
    BMC Fam Pract 13:128. 2012
    ....
  96. pmc Insurance trends for the Medicare population, 1991-1999
    Lauren A Murray
    Health Care Financ Rev 23:9-15. 2002
  97. pmc Choosing fee-for-service
    Lewis Draper
    Can Fam Physician 48:1612. 2002
  98. ncbi [Effects of D-DRG system on hospital financing on the example of septorhinoplasty]
    C Bermüller
    HNO Klinik, Uniklinik, Ulm, Germany
    Laryngorhinootologie 90:157-61. 2011
    ..The aim of the study was to investigate at a center for rhino-surgery the real effort for the different diseases and to assess the necessity of a new split in the DRG for septorhinoplasty...
  99. ncbi The road back to capitation?
    Jay Greene
    Healthplan 43:24-8. 2002
  100. ncbi Supporting your organization in managed care contracting
    Paul M Doelling
    BKD, LLP, St Louis, MO, USA
    OR Manager 18:1, 6-9. 2002
  101. ncbi A new risk management paradigm for managed care
    J M Kemka
    Actuarial Sciences Associates, Inc, Somerset, New Jersey, USA
    Healthc Financ Manage 54:41-3. 2000
    ....

Research Grants38

  1. Quality of Care in State Alcohol Treatment Systems
    Bentson McFarland; Fiscal Year: 2005
    ..Consequently, the methodology and the results will be of considerable interest to alcohol treatment clients, policy makers, and payers. ..
  2. MEDICAID MGD CARE FOR CHILDREN WITH SPEC HLTH CARE NEEDS
    JEAN MITCHELL; Fiscal Year: 2003
    ..abstract_text> ..
  3. Medicaid Managed Care & Access to Alcohol Treatment
    Bentson McFarland; Fiscal Year: 2004
    ..The investigators will explore application of hierarchical models and latent variable growth curves to the national data sets. The results will be of considerable interest to state Medicaid and alcohol drug abuse program directors. ..
  4. Standardized Patients as Drug Abuse Treatment Clients
    Bentson McFarland; Fiscal Year: 2004
    ..The proposed study will examine the feasibility and utility of SPs in this environment. ..
  5. Costs of Preventing Alcohol Problems in Older Adults
    Susan Ettner; Fiscal Year: 2007
    ..abstract_text> ..
  6. Medicaid cutbacks and clients with severe mental illness
    Bentson McFarland; Fiscal Year: 2007
    ..Analyses will take into account varying "times at risk" for subjects who may be hospitalized or arrested. The results will be of keen interest to decision-makers who determine Medicaid policies. [unreadable] [unreadable] [unreadable]..
  7. DRUG COURTS AND MEDICAID MANAGED BEHAVIORAL HEALTH CARE
    Bentson McFarland; Fiscal Year: 2003
    ..Process measures will include the modality and extent of drug abuse treatment services (as well as information gleaned from chart review). The results will be important for justice system and Medicaid policy makers. ..
  8. Ambulatory Patient Safety of Clients in Treatment for Substance Abuse
    Bentson McFarland; Fiscal Year: 2007
    ..The proposed planning project will set the stage for interventions as well as methodology to determine whether they are successful. [unreadable] [unreadable] [unreadable]..
  9. Impact of the Medicare Part D Benzodiazepine Exclusion on Managed Care Patients
    Susan Ettner; Fiscal Year: 2008
    ..Our findings will inform the ongoing debate over amending Part D legislation to include BZD coverage by providing objective data to guide policymakers on the likely costs and benefits. [unreadable] [unreadable] [unreadable]..
  10. Treatment Patterns, Expenditures and Outcomes in MBHOs
    Susan Ettner; Fiscal Year: 2005
    ..e., how psychotherapy visits are associated with outcomes and expenditures. Selection models will be used to estimate this relationship for patients with and without drug use. ..
  11. Structure, Use & Expenditures for Autism Services
    Joseph Morrissey; Fiscal Year: 2004
    ..abstract_text> ..
  12. Impact of Poor Health & AIDS on Small Businesses in SA
    Mark Pauly; Fiscal Year: 2003
    ..They will be useful for predicting the effect of changes in health on economic activity in this sector, and for allocating resources for disease prevention and treatment. ..
  13. Case Study of Hosp Based Center for Integrative Medicine
    Ian Coulter; Fiscal Year: 2004
    ..A detailed case study, using qualitative and quantitative research methods will yield a rich description that can facilitate future quantitative studies over a broader range of organizational models of integrative medicine. ..
  14. Competitive Continuation of Insurance Financing of Integrative Medicine
    Paula Diehr; Fiscal Year: 2007
    ..Since the United States is the world's number one consumer of medical care, this study on the addition of new CAM benefits and the consequences is important. [unreadable] [unreadable]..
  15. The Business Case for Disability Care Coordination
    Susan Palsbo; Fiscal Year: 2006
    ..unreadable] [unreadable] [unreadable] [unreadable]..
  16. SERVICE USE BY YOUTH WITH ALCOHOL AND MENTAL DISORDERS
    CRAIG HEFLINGER; Fiscal Year: 2002
    ..The project builds on program of health services research by the Principal Investigator that has focused on child, adolescent, and family behavioral health issues. ..
  17. CO-OCCURING DRUG AND MENTAL DISORDERS IN YOUTH
    CRAIG HEFLINGER; Fiscal Year: 2001
    ..The project builds on program of health services research by the Principal Investigator that has focused on child, adolescent, and family behavioral health issues. ..
  18. Substance Use Disorders & Service Use Among Rural Youth
    CRAIG HEFLINGER; Fiscal Year: 2007
    ..unreadable] [unreadable]..
  19. MODELING TREATMENT USE & EFFECTIVENESS IN MENTAL ILLNESS
    Sharon Lise Normand; Fiscal Year: 2007
    ..The methodological advances from this research will enable researchers, policy makers, and methodologists to better characterize factors impacting technology innovation/exnovation and to expand the inferences for usual care. ..
  20. Rural Child/Adolescent Mental Health Service Use
    CRAIG HEFLINGER; Fiscal Year: 2007
    ....
  21. Use of Complementary and Alternative Medical (CAM) Providers by Cancer Patients
    Paula Diehr; Fiscal Year: 2007
    ..This study will increase the understanding of the role CAM should play in providing supportive care for cancer patients. ..
  22. Economic and Policy Analyses in Geriatric Disease
    EKATERINA NOYES; Fiscal Year: 2006
    ..The model and analytical approaches acquired by the candidate during her training will be used later to develop a decision analytical model describing geriatric depression. ..
  23. Economic Impacts of New Drugs
    Sharon Lise Normand; Fiscal Year: 2006
    ..Finally, we will examine the proposition that offsets occur differentially across racial and ethnic groups, for high utilizers and according to the organization of insurance arrangements. [unreadable] [unreadable]..
  24. DETERMINING/UNDERSTANDING BARRIERS TO ADULT IMMUNIZATION
    Richard Zimmerman; Fiscal Year: 2001
    ..This project will furnish relevant, up-to-date to enhance policy planning, practice management and medical education. ..
  25. IMPACTS OF MANAGED CARE ON SA SERVICE LINKAGES
    Joseph Morrissey; Fiscal Year: 2002
    ..Findings will be related and communicated to program managers and directors who are engaged in providing appropriate and responsive care to this vulnerable population. ..
  26. PRICE INDEXES OF MENTAL HEALTH TREATMENT
    Richard Frank; Fiscal Year: 2002
    ..To assess outcomes we will use clinical literature along with three expert panels of clinician-researchers to rate expected outcomes for specific combinations of consumers and treatments. ..
  27. Specialty Mental Health Care--Expanding Access in an HMO
    Dominic Hodgkin; Fiscal Year: 2003
    ..The results will inform health plan decision-makers and others as they make utilization management choices that may have a major impact on patients and enrollee populations overall. ..
  28. Impact of 3 Tier Drug Copays on Use and Spending
    Dominic Hodgkin; Fiscal Year: 2003
    ..abstract_text> ..
  29. Race and Herbal Medications Among Medicare Recipients
    William Lafferty; Fiscal Year: 2004
    ..African- Americans already report lower satisfaction with their medical care and frequently leave the doctor's office with unanswered questions, therefore, special educational programs may be useful. ..
  30. Medicaid Capitation: Cost Shifting & Multisystem Use
    Joseph Morrissey; Fiscal Year: 2005
    ..Findings will be targeted to a variety of local and national audiences concerned about improving care for the various population groups involved. ..
  31. ANALYSIS OF MULTIPLE INFORMANT DATA IN PSYCHIATRY
    SHARON LISE TERESA NORMAND; Fiscal Year: 2010
    ..These novel and innovative methods will improve the assessment of treatment effects and will contribute to improving the health of the population. ..
  32. Nursing Effort and Quality in Long-Term Care Facilities
    Robert Kane; Fiscal Year: 2004
    ..The database consists of 3125 residents in 98 nursing units from 62 facilities. Results should shed light on the current policy debate over nursing home staffing standards. ..
  33. Developing Practice Improvement Research
    Susan Payne; Fiscal Year: 2007
    ..Research is needed to identify the most successful approaches to Ql, make the most effective use of scarce resources for Ql, and share the lessons learned in Maine with the rest of the nation. [unreadable] [unreadable] [unreadable]..
  34. Ethnic Minority Children in Public Mental Health
    Lonnie Snowden; Fiscal Year: 2006
    ..Similarly, we test the effect of clients' outpatient/linkage-brokerage use on ethnic disparities in crisis care use. ..
  35. HMO Selection Incentives and Underprovision of MH Care
    Zhun Cao; Fiscal Year: 2006
    ..abstract_text> ..
  36. Policies Improving Non-English Speakers' Access & Care
    Lonnie Snowden; Fiscal Year: 2009
    ....
  37. The Role of Customization in Psychotropic Prescribing
    Dominic Hodgkin; Fiscal Year: 2009
    ....