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At least 19 recordsLinked to original sources
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↗
PubMed1989

[Approach to the acceptability of the capitation fee system by the population in 3 integrated health centers of the Liège region].

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.

Belgium↗
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↗
PubMed1977

Prepaid group practice under universal health insurance in Canada.

This paper describes the experience of the two prepaid group practice plans in Ontario before and after universal health insurance. Both plans were capitalized, before national health insurance, by member contributions and both have had persistent problems with enrollment constraints and professional opposition. The Sault Ste. Marie Plan began in 1963, six years before Canadian medicare. The plan was paid a capitation fee for medical services but did not share in savings from its reduced hospital use. After universal insurance sharing in decreased hospital use was offset by regulations which allowed plan members to use non-plan physicians at Plan expense. Payments to non-plan physicians now take up 20 per cent of Plan income. Active enrollment of members has been replaced by a Ministry of Health registration system which is based on overall utilization. The St. Catharine's Plan began at the same time as universal insurance in 1969. Its out-of-plan use averaged about 40 per cent of total income. Most recently this program has shifted from capitation to cost-reimbursement payment. In Canada present trends include cost containment, financing by general tax revenues rather than premiums and increased categorical benefits. Under Canadian universal health insurance prepaid group practice has an uncertain future.

Canada↗
PubMed1992

Prediction of general practice workload from census based social deprivation scores.

STUDY OBJECTIVE: The aim was to compare the ability of census based social deprivation scores devised by Jarman, Carstairs, and Townsend to predict workload in general practice. DESIGN: This was a prospective study of 140,050 patients registered with general practices over one year from 1 July 1981 (Third National Morbidity Survey). Main outcome measures were workload score for each patient, defined as a weighted sum of consultations at the surgery and consultations elsewhere, excluding preventive procedures. SETTING: 25 general practices in England and Wales. MAIN RESULTS: In multivariate analyses the Jarman, Carstairs, and Townsend indices all predicted workload, but the Townsend index was the best predictor, with both housing tenure and car ownership being strong predictors of workload. The overcrowding and geographical mobility variables used in the Jarman index did not predict increased workload. The weighting assigned to children under five by the Jarman index underestimated the additional workload this group generated. CONCLUSIONS: For identifying social pressures on general practice workload the Jarman index is less valid than other census based scores because it fails to include car ownership and housing tenure. A more rational scheme for compensating general practitioners would directly weight the capitation fee for children aged under five years and allocate current deprivation payments according to the Townsend index or a similar score. This would redistribute resources from London to deprived areas in northern England.

Adolescent↗
PubMed1986

Primary health care in the United Kingdom.

General practice is one of the three bases of care in the British National Health Service (NHS); the other two are hospital and community services. Each is administered separately. There are 30,000 general practitioners (for a population of 57 million), who are independent and can organize their work as they see fit. Few are single-handed (13 percent) and the majority work in groups of three to five physicians. They are paid by capitation fees, and fees for specific services, and also receive reimbursements for staff, premises rental, and local taxes (rates). They work in close association with practice teams that include nurses, midwives, and social workers. There are no universal hospital privileges but many general practitioners hold appointments in local hospitals. Important trends in the NHS include mandatory vocational training of general practitioners for three years; the growing importance of attempts by the Royal College of General Practitioners to shift care from the hospital to the community; increased patient participation; clashes between the government and the medical profession over restricted funding of the NHS; definition and improvement of "quality," and a need for improved data collection; and long waits for hospital services.

Adult↗
PubMed1991

How well do family practitioner committee and general practice records agree? Experience in a semi-rural practice.

General practice notes may be inaccurate for various reasons. A study was carried out in one semi-rural practice to investigate the agreement between records held by the family practitioner committee and those kept in the practice. Details on the practice notes and the family practitioner committee list were compared for 800 patients. The details examined included name, sex, date of birth, address and National Health Service number. While 58% of records agreed, discrepancies occurred in 339 records (42%). The most common discrepancies concerned the patient's address (30.6%), date of birth (9.4%) and NHS number (8.0%). Nearly 5% of the practice notes appeared to be for patients who were no longer on the practice list or dependent on its care. These findings have implications under the new general practitioner contract where screening programmes, target related payments, and increased capitation fees require accurate practice records.

Documentation↗
PubMed1991

A national long-term care program for the United States. A caring vision. The Working Group on Long-term Care Program Design, Physicians for a National Health Program.

The financing and delivery of long-term care (LTC) need substantial reform. Many cannot afford essential services; age restrictions often arbitrarily limit access for the nonelderly, although more than a third of those needing care are under 65 years old; Medicaid, the principal third-party payer for LTC, is biased toward nursing home care and discourages independent living; informal care provided by relatives and friends, the only assistance used by 70% of those needing LTC, is neither supported nor encouraged; and insurance coverage often excludes critically important services that fall outside narrow definitions of medically necessary care. We describe an LTC program designed as an integral component of the national health program advanced by Physicians for a National Health Program. Everyone would be covered for all medically and socially necessary services under a single public plan, federally mandated and funded but administered locally. An LTC payment board in each state would contract directly with providers through a network of local public agencies responsible for eligibility determination and care coordination. Nursing homes, home care agencies, and other institutional providers would be paid a global budget to cover all operating costs and would not bill on a per-patient basis. Alternatively, integrated provider organizations could receive a capitation fee to cover a broad range of LTC and acute care services. Individual practitioners could continue to be paid on a fee-for-service basis or could receive salaries from institutional providers. Support for innovation, training of LTC personnel, and monitoring of the quality of care would be greatly augmented. For-profit providers would be compensated for past investments and phased out. Our program would add between $18 billion and $23.5 billion annually to current spending on LTC. Polls indicate that a majority of Americans want such a program and are willing to pay earmarked taxes to support it.

Aged↗
PubMed1987

[An assessment of the social welfare system in the United Kingdom].

This report describes the British social welfare system with reference to expected future developments in Japanese medical care. In developed countries where the average life expectancy is high, a large percentage of the population is elderly, resulting in high social welfare expenditure. In Britain, the "social welfare state", the average life expectancy is similar to that of other developed countries, while expenditure by the Department of Health and Social Security is considered to be the lowest. For example, expenditure on medical care for an average elderly man is approximately 60% of that in Japan. Some of the reasons are as follows. The family practitioner services are medical services given to patients by doctors of their own choice. The family doctor undertakes the initial diagnosis and management, but may refer the patients for either specialized services or hospital consultation. The general basis for remuneration of the family doctor is a standard capitation fee and an allowance. This system does not lead to over diagnosis or excessive treatment. The numbers of medical consultations performed and prescriptions issued by British doctors is lower than that in Japan. In Japan the number of elderly persons who are incapable of caring for themselves is increasing and poses not only a financial burden, but also a social problem. In the UK, these patients are cared for by social welfare workers (Japanese nurses) or at health centres (unlike Japanese hospitals and homes for the aged) which is less costly than inpatient hospital care. The Government is responsible for the National Health Service.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Capitation and fee-for-service dental benefit plans: economic incentives, utilization, and service-mix.

Insurance carriers, corporations, and labor groups are actively developing and marketing dental capitation benefit plans. Incentives to both dentists and patients in these plans differ from those in the traditional fee-for-service system used with conventional benefit plans. This paper describes the likely effects of these incentive differences on utilization and service-mix patterns in both systems. Data for a large (approximately 10,000), homogenous group of subscribers are presented and discussed. Faced with a dual option, at no cost to the employee, 60% of the subscribers chose the fee-for-service plan, and 40% chose the capitation plan. Observed differences in the utilization and mix of services between the two plans cannot be explained solely in terms of dentists' responses. Employee response to altered economic incentives appears to be strong.

Capitation Fee↗
PubMed1989

Preventive services in a hybrid capitation and fee-for-service setting.

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.

Adult↗
PubMed1992

Ambulatory testing for capitation and fee-for-service patients in the same practice setting: relationship to outcomes.

Previous studies of the impact of varying reimbursement incentives on physician behavior have not explored the simultaneous implications for patients' health outcomes. Using a single group of physicians who provided care for hypertensive patients with either capitation (N = 99) or fee-for-service (N = 66) health insurance plans, physicians' test-ordering behavior and patients' subsequent health outcomes were examined. After controlling for patients' age, severity of hypertension, and level of comorbidity, it was found that patients with capitation health insurance had fewer laboratory tests and lower overall charges than the fee-for-service patients, with no clinical or statistically significant differences in 1-year health outcomes, specifically blood pressure control. The study concludes that capitation can result in reduction in charges associated with management of hypertension, without apparent compromise in proximate health outcomes.

Adult↗