In many countries, competing health plans receive capitation payments from a sponsor, whether government or a private employer. All capitation payment methods are far from perfect and have raised concerns about risk selection. Paying health plans partly on the basis of capitation and partly on the basis of actual costs ("risk sharing") reduces plans' incentives for selection but sacrifices some...

OBJECTIVE To demonstrate cost-effectiveness analysis (CEA) for evaluating different reimbursement models. DATA SOURCES/STUDY SETTING The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (n=522). Under capitation, services were provided either directly (direct capitation [DC]) by not-for-profit community mental heal...

BACKGROUND When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. OBJECTIVES This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC)...

This article evaluates changes in the use of drug services and the corresponding costs when the conventional fee-for-service system for reimbursement of pharmacists under medicaid is replaced by a capitation system. The fee-for-service system usually covers ingredient costs plus a fixed professional dispensing fee. The capitation system provided a cash payment (which varied by aid category and ...

OBJECTIVE To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics. DESIGN Cross-sectional survey. SETTING One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, establis...

We develop a stylized principal-agent model with moral hazard and adverse selection to provide a unified framework for understanding some of the most salient features of the recent physician payment reform in Ontario and its impact on physician behavior. These features include the following: (i) physicians can choose a payment contract from a menu that includes an enhanced fee-for-service contr...

Understanding how physicians respond to incentives from payment schemes is a central concern in health economics research. We introduce a controlled laboratory experiment to analyse the influence of incentives from fee-for-service and capitation payments on physicians' supply of medical services. In our experiment, physicians choose quantities of medical services for patients with different sta...

APITATION and decapitation have nothing to do with each other, but you could hardly tell the difference when observing the intense debate over the value and risks of capitation in health care payment. Those who favor capitation seem to regard it as the sine qua non of effective containment of health care costs; those who oppose it suggest that it will spell nothing less than the end of medicine...

Risk theoretic analysis of capitation contracts suggests that capitation contracts are closely aligned to reinsurance contracts between insurance companies. Similarities and differences between these two forms of contractual instruments are reviewed, and several implications are discussed. Viewing capitation contracts as reinsurance contracts has implications that are incompatible with the over...