Am J Manag Care. 2010 Nov 1;16(11):e276-80.
To investigate the fairness of dental capitation insurance provider compensation amounts being paid by one of the nation's largest capitation insurance companies.
Analysis of insurance company documents.
The article first reports and then analyzes the capitation amounts paid by one of the nation's largest capitation plans over the past 13 years as retrieved directly from the insurance company documents. The annual rates of change in the capitation amounts are then compared with the annual rates of change in the mean dental office overhead expenses across the United States, as well as with the rates of change in income and expenses of the average US worker.
The compensation (capitation amount) paid to participating providers decreased dramatically every year over the past 13 years, while the mean office overhead costs of participating providers increased every year.
Solo general dentists with office overhead costs greater than or equal to the national mean likely find that the capitation amounts paid by insurance companies are an unfair compensation or are incompatible with their income objectives. Participation by solo general practitioners in capitation plans with such compensation levels would be problematic or unlikely.
调查美国最大的人头保险计划之一的保险公司支付的牙科人头保险提供商补偿金额的公平性。
保险公司文件分析。
本文首先报告，然后分析了一家全国最大的人头保险计划在过去 13 年中支付的人头金额，这些金额直接从保险公司文件中检索。然后将人头金额的年变化率与美国全国牙科诊所总运营成本的年变化率以及美国普通工人收入和支出的变化率进行比较。
在过去的 13 年中，参与计划的提供商每年的补偿（人头金额）都大幅下降，而参与计划的提供商的平均办公运营成本却逐年增加。
对于办公室运营成本高于或等于全国平均水平的个体全科牙医来说，保险公司支付的人头金额可能是不公平的补偿，或者与他们的收入目标不相符。个体全科医生参与这种补偿水平的人头保险计划可能会存在问题或不太可能。
