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Title
Modified capitation and treatment incentives for end stage renal disease.
First Author
Farley, Donna O
Date of Pub
1996 Spring
Pages
129-142
Volume
17
Issue
3
Other Authors
Carter, Grace M; Kallich, Joel D; Lucas, Thomas W; Spritzer, Karen L
Abstract
This study developed a modified capitation payment method for the Medicare end stage renal disease (ESRD) program designed to support appropriate treatment choices and protect health plans from undue financial risk. The payment method consists of risk-adjusted monthly capitated payments for individuals on dialysis or with functioning kidney grafts, lump sum event payments for expected incremental costs of kidney transplantations or graft failures, and outlier payments for expensive patients. The methodology explained 25 percent of variation in annual payments per patient. Risk adjustment captured substantial variations across patient groups. Outlier payments reduced health plan risk by up to 15 percent.
Abstract Continued
N/A
MeSH
Capitation Fee : Disability Evaluation : Health Care Costs : Health Maintenance Organizations/economics : Human : Insurance Selection Bias : Kidney Failure, Chronic/economics/epidemiology/surgery : Kidney Transplantation/economics : Medicare/classification/organization & administration : Models, Economic : Rate Setting and Review/methods : Risk Management : Support, U.S. Gov't, Non-P.H.S. : United States Health Care Financing Administration : United States/epidemiology
NTIS Number
PB99-106510