England W L
Health Care Financ Rev. 1986 Summer;7(4):67-73.
In late fall 1984, more than 110,000 Wisconsin Aid to Families with Dependent Children (AFDC) Medicaid recipients were enrolled in health maintenance organizations (HMO's). Capitation rates were set by competitive bidding, subject to a rate ceiling. Planners considered whether to adjust the rates to account for demographic changes in the AFDC population between the time that data for the rate ceilings were collected and when the rates went into effect. They also considered whether to pay a single rate or to adjust rates for the age and sex of each HMO's actual enrollees. This article is a report of the analysis that led to a decision to pay a single, countywide rate that was not demographically adjusted.
1984年秋末，超过11万名威斯康星州抚养儿童家庭援助计划（AFDC）的医疗补助受助者加入了健康维护组织（HMO）。按人头收费的费率通过竞争性投标确定，但有费率上限。规划者考虑是否调整费率，以考虑在收集费率上限数据之时至费率生效之时期间AFDC人口的人口结构变化。他们还考虑是支付单一费率，还是根据每个HMO实际参保人的年龄和性别调整费率。本文是一份分析报告，该分析导致决定支付一个未经人口结构调整的全县单一费率。
