The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch...

Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explai...

A change in payment system of general practitioners from capitation to a mix of one-half capitation and one-half fee for service in Copenhagen, Denmark, resulted in a significant overall increase in diagnostic and curative services. The rate of increase differs between services. In this article, it is assumed that the rate of increase varies with doctors' professional uncertainty relative to th...

Managed care organizations (MCOs) may be incurring financial losses from persons with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) (PWHA). This study developed a statistical model to examine which specific comorbidities are important contributors to the variations in health care costs of PWHA. Individuals were classified into cost groups to simulate biased sel...

We present results from a survey of Medicaid managed care payment methods and rates in 2001 for AFDC/TANF and poverty-related Medicaid populations, updating a similar survey of 1998 rates. Rates were adjusted for differences in age-sex groupings, maternity payments, and service carve-outs. A twofold variation in Medicaid capitation rates remains, although there was a change in the composition o...

THE Supreme Court has recently declared that right to education was a fundamental right and that the charging of capitation fee was arbitrary, unfair and therefore violative of the fundamental right to equality contained in article 14 of the Constitution. Since the decision of the Supreme Court is the law of the land, the above decision has created a storm in the educational world. The immediat...

The UK Renal Registry (UKRR) continues to provide a national source of NHS healthcare data on patients dependent on renal replacement therapy (RRT) across the four nations. Using electronic reporting and substantial integration across the 71 adult and 13 paediatric renal centres independent audit and analysis of dialysis and transplant activity and care across the UK is provided. The UKRR is pa...

This article examines the methodology New York State used to set capitation rates for a Medicaid health maintenance organization. By examining the methods used and the assumptions made in a particular case, some general lessons are drawn about the ratesetting process. Greater reliance on statewide data to assure fair and statistically stable estimates is needed. Although the article focuses on ...