BACKGROUND: Publicly funded mental health systems are increasingly implementing managed care systems, such as capitation, to control costs. Capitated contracts may increase the risk for disenrollment or adverse outcomes among high cost clients with severe mental illness. Risk-adjusted payments to providers are likely to reduce providers' incentives to avoid or under-treat these people. However,...

Other-regarding motivation is a fundamental determinant of public service provision. In health care, one example is physicians who act benevolently towards their patients when providing medical services. Such patient-regarding motivation seems closely associated with a personal sacrifice that health service providers are willing to make. Surprisingly, evidence on physicians' motivation is rare....

BACKGROUND In 1995 in an effort to control costs, the State of Colorado implemented a pilot capitated payment system for individuals eligible for public financing of their mental health services. Contracts were with both Not-For-Profit (NFP) firms and For-Profit (FP) firms; the remainder were in the fee-for-service system (FFS). Pharmaceuticals were not included in the capitation rate. However,...

LA RÉFORME DES SOINS MÉDICAUX PRIMAIRES AU CANADA attire de plus en plus d’attention, surtout de la part des gouvernements préoccupés par les coûts imprévisibles et la mauvaise répartition des médecins. La mise en oeuvre d’un mode de financement fondé sur la population suscite beaucoup d’intérêt. La capitation et l’inscription sont répandues dans certains pays d’Europe, mais les données probant...

Important variations in access to health care and health outcomes are associated with geography, giving rise to profound ethical concerns. This paper discusses the consequences of such concerns for the allocation of health care finance to geographical regions. Specifically, it examines the ethical drivers underlying capitation systems, which have become the principal method of allocating health...

A key issue in the decades-long struggle over US health care spending is how to distribute liability for expenses across all market participants, from insurers to providers. The rise and abandonment in the 1990s of capitation payments—lump-sum, per person payments to health care providers to provide all care for a specified individual or group—offers a stark example of how difficult it is for p...

As Medicare beneficiary enrollment in managed care plans increases, and as Congress considers relying on capitation for achieving savings in the program, the question of finding a fair and equitable formula for determining the monthly payment to managed care plans has become increasingly salient. This DataWatch focuses on one dimension of using previous expenditures to determine annual capitati...

R cforms in the nation's healthcare system are raising the pressure on managed care plans to capitate payments to physicians and hospitals, said David N . Schopp at the seminar " U n d e r s t a n d i n g Capitation and Risk Sharing," held following the Catholic Health Assembly (pp. 33-59). Insurance reforms, Schopp explained, will prevent a plan from using experience rating—that is, raising pr...