Shmueli A
Hebrew University School of Public Health, Jerusalem, and Gertner Institute for Health Policy Research, Israel.
Health Econ. 1999 Sep;8(6):547-52. doi: 10.1002/(sici)1099-1050(199909)8:6<547::aid-hec463>3.0.co;2-u.
Setting risk-adjusted capitation rates in health systems with centralized financing and decentralized delivery is one of the most intriguing policy issues. The common practice to set capitation group rates is based on individual data collected from either population surveys or medical records, using a single-and in most cases arbitrary-set of relative unit costs of services. This paper presents a method for estimating group-specific mean costs and capitation rates using a panel of aggregate cost data of the competing health plans and the composition of their populations. This method is used to estimate mean costs and capitation rates for the Israeli health care system. The limited data available severely constrains the range of estimable models, however, the results evoke some questions with regards to reimbursement and rates presently used, as well as to the methodology used to estimate them.
在实行集中融资和分散服务的卫生系统中设定风险调整后的人头费率是最具吸引力的政策问题之一。设定人头费率组的常见做法是基于从人口调查或医疗记录中收集的个体数据，使用单一的（而且在大多数情况下是任意设定的）一组服务相对单位成本。本文提出了一种使用竞争卫生计划的汇总成本数据面板及其人口构成来估计特定组平均成本和人头费率的方法。该方法用于估计以色列医疗保健系统的平均成本和人头费率。然而，可用数据有限严重限制了可估计模型的范围，结果引发了一些关于目前使用的报销和费率以及用于估计它们的方法的问题。
