BACKGROUND Doctors' professional behaviour is influenced by the way they are paid. When GPs are paid per item, i.e., on a fee-for-service basis (FFS), there is a clear relationship between workload and income: more work means more money. In the case of capitation based payment, workload is not directly linked to income since the fees per patient are fixed. In this study list size was considered...

BACKGROUND To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ...

When capitated doctors are sued for non-referral to specialists, typical charges include that the capped network's PMPM rates served as a disincentive to refer. So far none of the charges have prevailed. Physicians also are winning lawsuits alleging inadequate capitation rates from HMOs.

AIM To offer a capitation formula with greater capacity for guiding resource spending on population with poorer health and lower socioeconomic status in the context of financing and equity in primary health care. METHODS We collected two years of data on a sample of 10,000 individuals from a region in Chile, Valdivia and Temuco and evaluated three models to estimate utilization and expenditur...

This Data Watch presents data on geographic variation in medical costs across a sample of forty-six cities, using enrollment-weighted average Federal Employees Health Benefits Program (FEHBP) health maintenance organization (HMO) premiums. Variation of average HMO premiums is markedly less than variation of per capita fee-for-service costs as measured by Medicare's adjusted average per capita c...

The general medical services (GMS) scheme provides care free at the point of use for the 30% most economically deprived section of the population and the elderly. Almost all people of over-70-year olds are eligible for the GMS scheme potentially directing resources away from those most in need. The aim of this study is to analyse the relationship between practice GMS income and deprivation amon...

This paper considers the relative healthcare expenditure needs of England, Wales, Scotland and Northern Ireland. It applies the NHS weighted capitation formula – used to allocate resources to English Primary Care Trusts – to Health Boards in Wales and Scotland and Health and Social Care Trusts in Northern Ireland. According to this formula, per capita healthcare expenditure need in Wales is 16%...

BACKGROUND We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. METHODS We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias...