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Congress has repeatedly proposed changing Medicaid from an entitlement to a block grant. Each state would receive a fixed amount instead of a Federal payment influenced by state decisions on eligibility, coverage, and pricing. This paper uses existing data series to simulate redistributing the annual $353 billion Federal payment among Medicaid's 56 state (and territorial) programs. Capitation by general population would shift $52 billion, mainly from large Northeastern and West Coast states to large Southern and Mountain states. Capitation by population below the Federal Poverty Line (FPL) would shift $60 billion in a similar pattern. Policymakers should understand likely state-to-state effects when considering Medicaid legislation. States could then prepare for possible changes in their Federal payment for Medicaid.

AbstractA mental health capitation experiment in Rochester, New York, is evaluating the costs and outcomes of giving a prospectively determined fixed payment to community agencies to assume responsibility and accountability for caring for as many as 1,800 seriously mentally ill patients.

AbstractIn addition to being an effective means to reform a system of care, the use of capitation funding in Arizona is yielding useful information.

AbstractCapitation is increasingly advocated as a budgeting strategy to consolidate resources, develop services, focus responsibility, and manage care appropriately for the long‐term mentally ill. Devising capitation systems is complex, and innovators should proceed cautiously.

The major impetus for health care reform clearly seems to be the desire to contain the cost of health care. One of the major cost‐containment methods proposed is capitation. Capitation poses specific problems when applied to mental health services delivery. This article discusses several of the major issues pertaining to the utility of capitation in mental health, discusses on‐going capitation efforts, and provides an evaluation of capitation programs. Future directions for research on capitation in mental health are then suggested.

Part of a symposium on "Studies in Mental Health Policy" (see related abstracts in SOPODA 17:2). Capitation, a major cost containment proposal for health care reform, poses specific problems when applied to mental health services delivery. Major issues pertaining to the utility of capitation in mental health are discussed in the context of a review & evaluation of ongoing capitation efforts. Future directions for research on capitation in mental health are suggested. 23 References. Adapted from the source document.

AbstractPhiladelphia is designing a plan for public mental health services that consolidates state and county funding with Medicaid funding for acute inpatient and ambulatory psychiatric services to create a managed system of care for the seriously mentally ill.

__Abstract__ In many countries the concept of capitating health care insurers is receiving increasing attention. The main reason is, that capitation may induce health care insurers in a competitive environment to concentrate more on cost containment. However, if the adjusters on which capitation payments are based, are too global, there may be ample room for risk selection by the insurers whilst also an unfair distribution of funds over the insurers may result, thereby undermining the objectives of capitation. The prime motivation for the present study is, that the Dutch government, as part of proposals for a new, market oriented structure of health care system, is considering to capitate insurers on the basis of global parameters like age, gender and location. Our analysis based on panel data of some 35,000 individuals, shows that the proportion of variance in annual health care expenditures that can be predicted (R2) by such a global capitation formula, is only 0.024. This is less than of our estimate of the theoretically maximum achievable R2 which amounts to 0.138, implying the existence of abundant selection oppurtunities, e.g. on the basis of past expenditures or other health indicators. Alternative capitation formulae incorporating prior-year's costs and reaching about of the maximum obtainable R2, effectively remove the profitableness of selection on the basis of past expenditures. The findings suggest, however, that selection via (chronic) health status may still be profitable to some extent. Therefore, we also analyzed data from the Dutch Health Interview Survey (N ≈ 20,000) which comprised better health indicators. It appeared that a capitation formula based on the global adjusters mentioned above as well as three health status indicators and several background characteristics, yields an R2 of about 0.114, which probably accounts for of our estimate of the maximum obtainable R2. The main conclusion is, that in the short term information on prior expenditures, which is available in the files of most insurers and thus may be used for risk selection, should be included in the capitation formula. For the more distant duture, the formula should be expanded with indicators of chronic health status, possibly based on diagnostic information from previous, non-discretionary hospitalizations.

As a result of rising health care costs, many countries, including the United States, have turned to managed care organizations and the use of capitation payment systems. Although this type of system is an effective mechanism for reducing excessive utilization of health care, it may lead to the underprovision of medical services. In this paper propensity to underprovide medical services in a prepayment system as well as the effects of auditing/monitoring on physician behaviour and patient well‐being are examined. Conditions are found under which managed care yields more efficient outcomes than traditional fee‐for‐service care.Suite à la croissance importante des coûts des soins, plusieurs pays, y compris les Etats Unis, ont commencéà se tourner vers des organisations spécialisées pour gérer la prestation des services et à faire usage de systèmes de rémunération per capita. Même si ce genre de système est un mécanisme efficace pour réduire l'usage excessif des service de santé, il peut entraîner une offre déficiente de services médicaux. Ce mémoire examine la propensitéà fournir moins de services dans un système de pré‐paiement. On examine aussi les effets de la surveillance et de la vérification sur le comportement des médecins et sur le bien‐être des patients. On met en lumière les conditions qui assurent que les soins fournis dans un tel système donneront de meilleurs résultats que la rémunération à l'acte.

In many countries the concept of capitating health care insurers is receiving increasing attention. The main reason is, that capitation may induce health care insurers in a competitive environment to concentrate more on cost containment. However, if the adjusters on which capitation payments are based, are too global, there may be ample room for risk selection by the insurers whilst also an unfair distribution of funds over the insurers may result, thereby undermining the objectives of capitation. The prime motivation for the present study is, that the Dutch government, as part of proposals for a new, market oriented structure of health care system, is considering to capitate insurers on the basis of global parameters like age, gender and location. Our analysis based on panel data of some 35,000 individuals, shows that the proportion of variance in annual health care expenditures that can be predicted (R 2 ) by such a global capitation formula, is only 0.024. This is less than 1 5 of our estimate of the theoretically maximum achievable R 2 which amounts to 0.138, implying the existence of abundant selection oppurtunities, e.g. on the basis of past expenditures or other health indicators. Alternative capitation formulae incorporating prior-year's costs and reaching about 3 5 of the maximum obtainable R 2 , effectively remove the profitableness of selection on the basis of past expenditures. The findings suggest, however, that selection via (chronic) health status may still be profitable to some extent. Therefore, we also analyzed data from the Dutch Health Interview Survey (N ≈ 20,000) which comprised better health indicators. It appeared that a capitation formula based on the global adjusters mentioned above as well as three health status indicators and several background characteristics, yields an R 2 of about 0.114, which probably accounts for 3 4 of our estimate of the maximum obtainable R 2 . The main conclusion is, that in the short term information on prior expenditures, which is available in the files of ...

AbstractRecent experience with capitated mental health care in publicly and privately financed plans highlights important problems with prepaid care but also suggests methods for adapting capitation to make it more compatible with high‐quality care for the mentally ill.