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Capitation and the Medicare program: history, issues, and evidence.

Langwell KM, Hadley JP - Health Care Financ Rev (1986)

Bottom Line: This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation.Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of services.In addition, areas requiring further study are noted, and the potential for extensions of capitation under Medicare are explored.

View Article: PubMed Central - PubMed

ABSTRACT
This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation. Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of services. In addition, areas requiring further study are noted, and the potential for extensions of capitation under Medicare are explored.

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Total Medicare prepaid contracts: United States, 1979 and 1986
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Related In: Results  -  Collection


getmorefigures.php?uid=PMC4195086&req=5

f2-hcfr-86-supp-009: Total Medicare prepaid contracts: United States, 1979 and 1986

Mentions: As shown in Figures 1 and 2, by December 31, 1979 (13 years after the inception of the Medicare program), only 64 organizations, with a total enrollment of 527,521 beneficiaries, had signed contracts with the Medicare program. Thirty-two of these organizations were group practice prepayment plans (484,755 beneficiaries enrolled), 31 HMO's had cost contracts with Medicare (23,498 beneficiaries enrolled), and 1 plan had a risk contract with Medicare (19,268 beneficiaries enrolled). Medicare's relative lack of success in attracting HMO's to participate in the program, particularly on a risk basis, can be attributed to the fact that the contracting options offered by Medicare failed to provide HMO's with sufficient financial incentives. In addition, the retrospective cost-based reimbursement and cost-finding procedures used by Medicare differed substantially from the usual procedures of HMO's relying on prospectively determined rates.


Capitation and the Medicare program: history, issues, and evidence.

Langwell KM, Hadley JP - Health Care Financ Rev (1986)

Total Medicare prepaid contracts: United States, 1979 and 1986
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195086&req=5

f2-hcfr-86-supp-009: Total Medicare prepaid contracts: United States, 1979 and 1986
Mentions: As shown in Figures 1 and 2, by December 31, 1979 (13 years after the inception of the Medicare program), only 64 organizations, with a total enrollment of 527,521 beneficiaries, had signed contracts with the Medicare program. Thirty-two of these organizations were group practice prepayment plans (484,755 beneficiaries enrolled), 31 HMO's had cost contracts with Medicare (23,498 beneficiaries enrolled), and 1 plan had a risk contract with Medicare (19,268 beneficiaries enrolled). Medicare's relative lack of success in attracting HMO's to participate in the program, particularly on a risk basis, can be attributed to the fact that the contracting options offered by Medicare failed to provide HMO's with sufficient financial incentives. In addition, the retrospective cost-based reimbursement and cost-finding procedures used by Medicare differed substantially from the usual procedures of HMO's relying on prospectively determined rates.

Bottom Line: This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation.Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of services.In addition, areas requiring further study are noted, and the potential for extensions of capitation under Medicare are explored.

View Article: PubMed Central - PubMed

ABSTRACT
This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation. Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of services. In addition, areas requiring further study are noted, and the potential for extensions of capitation under Medicare are explored.

Show MeSH