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Title
Risk adjustment for a children's capitation rate.
First Author
Newhouse, Joseph P
Date of Pub
1993 Fall
Pages
39-54
Volume
15
Issue
1
Other Authors
Keeler, Emmett B; Manning Jr, Willard G; Sloss, Elizabeth M
Abstract
Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping.
Abstract Continued
N/A
MeSH
Capitation Fee : Ambulatory Care/economics/statistics & numerical data : Analysis of Variance : Child : Child Health Services/economics/utilization : Data Collection : Health Expenditures/statistics & numerical data : Health Maintenance Organizations/economics/utilization : Health Services Research : Health Status Indicators : Human : Income/statistics & numerical data : Medicare/organization & administration : Models, Statistical : Rate Setting and Review/methods : Risk : Support, U.S. Gov't, Non-P.H.S. : United States
NTIS Number
PB95-123493