按人头付费的医疗保险费率调整器。
Rate adjusters for Medicare under capitation.
作者信息
Newhouse J P
出版信息
Health Care Financ Rev. 1986;1986(Spec No):45-55.
Abstract
This article addresses three issues related to capitation. First, the average adjusted per capita cost (AAPCC) fluctuates with the mix of risks in the fee-for-service system. More sensitive adjusters in the AAPCC are needed. Second, the AAPCC, as now estimated, exhibits large geographic variance; so-called shrinkage estimators may help. Third, the AAPCC requires new adjusters to yield more homogeneous risk classes. Otherwise, the portion of the Medicare population under capitation may experience access problems at alternative delivery systems. Until such adjusters are developed, it seems better to rely upon a blend of capitation and fee-for-service than the present AAPCC.
摘要
本文探讨了与按人头付费相关的三个问题。第一，平均调整后人均成本（AAPCC）会随着按服务收费系统中的风险组合而波动。AAPCC需要更敏感的调整因素。第二，目前估算的AAPCC存在很大的地区差异；所谓的收缩估计量可能会有所帮助。第三，AAPCC需要新的调整因素以产生更同质化的风险类别。否则，按人头付费的医疗保险人群在替代服务提供系统中可能会遇到就医问题。在开发出此类调整因素之前，采用按人头付费和按服务收费相结合的方式似乎比目前的AAPCC更好。
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本文引用的文献
1
Hospital 'profits': the effects of reimbursement policies.
J Health Econ. 1982 May;1(1):29-52. doi: 10.1016/0167-6296(82)90020-0.
2
Functional health measure for adjusting health maintenance organization capitation rates.
Health Care Financ Rev. 1986 Spring;7(3):85-95.
3
Using prior utilization to determine payments for Medicare enrollees in health maintenance organizations.
Health Care Financ Rev. 1985 Spring;6(3):27-38.
4
Pre-enrollment reimbursement patterns of Medicare beneficiaries enrolled in "at-risk" HMOs.
Health Care Financ Rev. 1982 Sep;4(1):55-73.
5
Differences by age groups in health care spending.
Health Care Financ Rev. 1980 Spring;1(4):65-90.
6
Risk differential between Medicare beneficiaries enrolled and not enrolled in an HMO.
Health Care Financ Rev. 1980 Winter;1(3):91-9.
7
Improving the Medicare HMO payment formula to deal with biased selection.
Adv Health Econ Health Serv Res. 1985;6:101-26.
8
Hospital rate review. A theory and an empirical review.
J Health Econ. 1984 Apr;3(1):25-47. doi: 10.1016/0167-6296(84)90024-9.
9
Provider behavior under prospective reimbursement. Cost sharing and supply.
J Health Econ. 1986 Jun;5(2):129-51. doi: 10.1016/0167-6296(86)90002-0.
10
What is adverse about adverse selection?
Adv Health Econ Health Serv Res. 1985;6:281-6.
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