Pricing strategies for capitated delivery systems.
Date of Pub
Tompkins, Christopher P; Wallack, Stanley S
This article discusses alternative methods for establishing a fairer pricing mechanism for Medicare recipients who enroll
in health maintenance organizations and other competitive medical plans. The current method, based upon the adjusted average
per capita cost, is inadequate because it fails to adjust premium levels for differences in health status; it establishes
undesirable incentives that may lead to underservice, and it is tied to costs in the fee-for-service system. Alternative methods
would incorporate health status, have Medicare share the risk with HMO's, and base payment on HMO experience.
Capitation Fee : Fees and Charges : Reimbursement Mechanisms : Aged : Health Maintenance Organizations/economics : Human :
Medicare/economics : Models, Theoretical : Rate Setting and Review/methods : United States : United States Health Care Financing