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Controlling risk in capitation payment. Multivariate definitions of risk groups.

Publication ,  Journal Article
Manton, KG; Tolley, HD; Vertrees, JC
Published in: Medical care
March 1989

There are a number of different reimbursement strategies proposed for health maintenance organization (HMO) style health care providers. Each of those strategies is designed to leave the provider at risk to provide incentives for him to increase the efficiency of his organization. Many such systems do not include as underwriting factors the medical status of the patient. Failure to include adjustment for the patient's medical status can: 1) leave the provider at risk due to real variation in the mix of the medical needs of the enrolled population (i.e., in areas with a sicker than average patient population, HMOs can fail by simply providing appropriate levels of care) and 2) provide incentives for selective enrollment and disenrollment based on the beneficiaries' medical status to see if such financial loss can be avoided. The authors analyzed two capitation reimbursement scenarios with adjustments for medical status to see if such adverse effects could be avoided while maintaining incentives for efficiency.

Duke Scholars

Published In

Medical care

DOI

EISSN

1537-1948

ISSN

0025-7079

Publication Date

March 1989

Volume

27

Issue

3

Start / End Page

259 / 272

Related Subject Headings

  • United States
  • South Carolina
  • Risk Factors
  • Risk
  • Models, Theoretical
  • Medicare
  • Health Services
  • Health Policy & Services
  • Health Maintenance Organizations
  • Fees and Charges
 

Citation

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Manton, K. G., Tolley, H. D., & Vertrees, J. C. (1989). Controlling risk in capitation payment. Multivariate definitions of risk groups. Medical Care, 27(3), 259–272. https://doi.org/10.1097/00005650-198903000-00004
Manton, K. G., H. D. Tolley, and J. C. Vertrees. “Controlling risk in capitation payment. Multivariate definitions of risk groups.Medical Care 27, no. 3 (March 1989): 259–72. https://doi.org/10.1097/00005650-198903000-00004.
Manton KG, Tolley HD, Vertrees JC. Controlling risk in capitation payment. Multivariate definitions of risk groups. Medical care. 1989 Mar;27(3):259–72.
Manton, K. G., et al. “Controlling risk in capitation payment. Multivariate definitions of risk groups.Medical Care, vol. 27, no. 3, Mar. 1989, pp. 259–72. Epmc, doi:10.1097/00005650-198903000-00004.
Manton KG, Tolley HD, Vertrees JC. Controlling risk in capitation payment. Multivariate definitions of risk groups. Medical care. 1989 Mar;27(3):259–272.

Published In

Medical care

DOI

EISSN

1537-1948

ISSN

0025-7079

Publication Date

March 1989

Volume

27

Issue

3

Start / End Page

259 / 272

Related Subject Headings

  • United States
  • South Carolina
  • Risk Factors
  • Risk
  • Models, Theoretical
  • Medicare
  • Health Services
  • Health Policy & Services
  • Health Maintenance Organizations
  • Fees and Charges