Capitation Payment Research Articles

FAKTOR-FAKTOR YANG MEMPENGARUHI CASH HOLDING PADA PERUSAHAAN MANUFAKTUR

The purpose of this empirical research is to examine about the effect of profitability, firms size, leverage, and capital expenditure on cash holding in manufacturing companies listed on the Indonesia Stock Exchange from 2015 to 2017. The research used 60 manufacturing companies that were selected using purposive sampling method for a total of 180 data in three years. Data processing techniques used are Eviews version 9.0. This research used panel data regression analysis. The results of this research shows profitability, leverage, and capital expenditurehave effects on cash holding, and firm size have no effect on cash holding. Siggestions that can be given are for further research to be expected to use other independent variables such as liquidity, cash flow, working capital, inventory turnover, and dividend payment that may show better results.

Cost calculation of dental service at Pratama Clinic using Activity-based Costing method in Padang, West Sumatera, Indonesia

Aim: Indonesian health-care system evolution is attributed to billing and insurance of the health service, especially on basic dental service through capitation payment. Administrative cost estimation is important to equalize the allocation of health insurance expenditure spread over the dental clinic in Indonesia. The aim of this study was to calculate unit cost value at urban and suburban dental services at Pratama Clinic at Padang, West Sumatera, Indonesia. Materials and Methods: Two dental services at Pratama clinics at urban and suburban areas selected by random sampling. Unit cost patient day was applied by Activity-Based Costing method. Statistical analysis: The cost was calculated by using computerized Microsoft Excel analysis. Results: Suburban dental service Pratama Clinic has higher activity driver value than urban counterpart, but there is no significant difference between resource driver at urban and suburban dental service Pratama Clinic. The unit cost calculation of dental service at urban and suburban Pratama Clinic is US$5.26 and US$5.36, respectively. Conclusion: These findings outline that unit cost value at suburban is higher than urban dental service Pratama Clinic. So, these usefull to provide the basic information regarding the government to implement the equal and efficient health-care expenditure, particularly on each area in Indonesia.

Physician reimbursement for outpatient dialysis care: Past, present, and future

Ever since Medicare began covering nearly every patient with end-stage renal disease in the United States, reimbursement for dialysis services has deviated from traditional fee-for-service. The method of reimbursing physicians for outpatient dialysis care has undergone a series of reforms in an effort to improve the overall quality of dialysis care and to control healthcare costs-changes that we are still seeing today. In 2004, the Centers for Medicare and Medicaid Services (CMS) changed the Monthly Capitation Payment (MCP) for physician reimbursement to the tiered fee-for-service system that is used today. This most recent reform encouraged more frequent face-to-face visits to patients receiving dialysis. While the quantity of visits increased in response to the change in reimbursement, the quality of care did not meaningfully improve, the policy may have had unintended negative health consequences and may have led to increases in wasteful physician and advanced practitioner effort. There are several promising opportunities to reform economic incentives around physician dialysis care that could improve the quality and value of care. These include new pay-for-performance initiatives, implementing incentives for high-quality care within fully capitated payment models, and reforming the MCP itself to link payment to high-value dialysis services.

Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study

Background Policy-makers wanted to reform the NHS dental contract in Northern Ireland to contain costs, secure access and incentivise prevention and quality. A pilot project was undertaken to remunerate general dental practitioners using a capitation-based payment system rather than the existing fee-for-service system. Objective To investigate the impact of this change in remuneration. Design Mixed-methods design using a difference-in-difference evaluation of clinical activity levels, a questionnaire of patient-rated outcomes and qualitative assessment of general dental practitioners’ and patients’ views. Setting NHS dental practices in Northern Ireland. Participants General dental practitioners and patients in 11 intervention practices and 18 control practices. Interventions Change from fee for service to a capitation-based system for 1 year and then reversion back to fee for service. Main outcome measures Access to care, activity levels, service mix and financial impact, and patient-rated outcomes of care. Results The difference-in-difference analyses showed significant and rapid changes in the patterns of care provided by general dental practitioners to patients (compared with the control practices) when they moved from a fee-for-service system to a capitation-based remuneration system. The number of registered patients in the intervention practices compared with the control practices showed a small but statistically significant increase during the capitation period (p < 0.01), but this difference was small. There were statistically significant reductions in the volume of activity across all treatments in the intervention practices during the capitation period, compared with the control practices. This produced a concomitant reduction in patient charge revenue of £2403 per practice per month (p < 0.05). All outcome measures rapidly returned to baseline levels following reversion from the capitation-based system back to a fee-for-service system. The analysis of the questionnaires suggests that patients did not appear to notice very much change. Qualitative interviews showed variation in general dental practitioners’ behaviour in response to the intervention and how they managed the tension between professional ethics and maximising the profits of their business. Behaviours were also heavily influenced by local context. Practice principals preferred the capitation model as it freed up time and provided opportunities for private work, whereas capitation payments were seen by some principals as a ‘retainer fee’ for continuing to provide NHS care. Non-equity-owning associates perceived the capitation model as a financial risk. Limitations The active NHS pilot period was only 1 year, which may have limited the scope for meaningful change. The number of sites was restricted by the financial budget for the NHS pilot. Conclusions General dental practitioners respond rapidly and consistently to changes in remuneration, but differences were found in the extent of this change by practice and provider type. A move from a fee-for-service system to a capitation-based system had little impact on access but produced large reductions in clinical activity and patient charge income. Patients noticed little difference in the service that they received. Future work With changing population need and increasing financial pressure on the NHS, research is required on how to most efficiently meet the expectations of patients within an affordable cost envelope. Work is also needed to identify and evaluate interventions that can complement changes in remuneration to meet policy goals. Trial registration Current Controlled Trials ISRCTN29840057. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.

Attribute development and level selection for a discrete choice experiment to elicit the preferences of health care providers for capitation payment mechanism in Kenya

BackgroundStated preference elicitation methods such as discrete choice experiments (DCEs) are now widely used in the health domain. However, the “quality” of health-related DCEs has come under criticism due to the lack of rigour in conducting and reporting some aspects of the design process such as attribute and level development. Superficially selecting attributes and levels and vaguely reporting the process might result in misspecification of attributes which may, in turn, bias the study and misinform policy. To address these concerns, we meticulously conducted and report our systematic attribute development and level selection process for a DCE to elicit the preferences of health care providers for the attributes of a capitation payment mechanism in Kenya.MethodologyWe used a four-stage process proposed by Helter and Boehler to conduct and report the attribute development and level selection process. The process entailed raw data collection, data reduction, removing inappropriate attributes, and wording of attributes. Raw data was collected through a literature review and a qualitative study. Data was reduced to a long list of attributes which were then screened for appropriateness by a panel of experts. The resulting attributes and levels were worded and pretested in a pilot study. Revisions were made and a final list of attributes and levels decided.ResultsThe literature review unearthed seven attributes of provider payment mechanisms while the qualitative study uncovered 10 capitation attributes. Then, inappropriate attributes were removed using criteria such as salience, correlation, plausibility, and capability of being traded. The resulting five attributes were worded appropriately and pretested in a pilot study with 31 respondents. The pilot study results were used to make revisions. Finally, four attributes were established for the DCE, namely, payment schedule, timeliness of payments, capitation rate per individual per year, and services to be paid by the capitation rate.ConclusionBy rigorously conducting and reporting the process of attribute development and level selection of our DCE,we improved transparency and helped researchers judge the quality.

Does capitation affect patient satisfaction and prevalence of out-of-pocket payments in the insured? A propensity score analysis of Ghana\u2019s demographic and health survey data

BackgroundGhana’s National Health Insurance Scheme (NHIS) piloted capitation payment for primary care services in the Ashanti region from 2012 to 2017. Capitation was piloted as a means of cost containment but also to induce managed competition among health providers to improve the responsiveness of healthcare delivery. This study examined the effects of exposure to capitation on perceived health service quality and prevalence of out-of-pocket payments in NHIS insured clients.MethodsRespondents of the 2014 Ghana Demographic and Health Survey (G-DHS) who reported having a valid NHIS card as their only form of health insurance coverage and made a health facility visit within the 6 months prior to the survey were used to assess the exposure effects of capitation on four outcomes: overall patient satisfaction, perceived friendliness of health staff, perceived adequacy of consultation time, and prevalence of out-of-pocket payments. We applied propensity score matching to balance distributions of covariates and to compare outcomes between exposed NHIS insured clients and their unexposed counterparts.ResultsNHIS insured clients exposed to capitation had 10 percentage points higher probability of encountering out-of-pocket payments than their unexposed counterparts (p = 0.009; 95% CI: 2.5–17.8%). There was no evidence of a difference between the two exposure groups for ratings of the three quality perceptions outcomes examined: overall patient satisfaction, difference 0.63 units (p = 0.46); perceived friendliness of health staff, difference 1.1% (p = 0.50); and perceived adequacy of consultation times, difference 0.1% (p = 0.96).ConclusionIn the Ghanaian context, our results suggest capitation was associated with a greater probability of out-of-pocket payments and no difference in perceived service quality. Future research should examine clinical quality of healthcare and how much out-of-pocket payment occurred under capitation.

A game theoretic setting of capitation versus fee-for-service payment systems.

We aim to determine whether a game-theoretic model between an insurer and a healthcare practice yields a predictive equilibrium that incentivizes either player to deviate from a fee-for-service to capitation payment system. Using United States data from various primary care surveys, we find that non-extreme equilibria (i.e., shares of patients, or shares of patient visits, seen under a fee-for-service payment system) can be derived from a Stackelberg game if insurers award a non-linear bonus to practices based on performance. Overall, both insurers and practices can be incentivized to embrace capitation payments somewhat, but potentially at the expense of practice performance.

The Impact of Mental Health Conditions on Public Insurance Costs of Treating HIV/AIDS

Medicare and Medicaid insurance claims data for Californians living with HIV are analyzed in order to determine: (1)The prevalence of treatment for particular mental health diagnoses among people living with HIV (PLWH) with Medicare or Medicaid insurance in 2010; (2)The relationship between individual mental health conditions and total medical care expenditures; (3)The impact of individual mental health diagnoses on the cost of treating non-mental health conditions; and (4)The implications of the cost of mental health diagnoses for setting managed care capitation payments. We find that the prevalence of mental health conditions among PLWH is high (23% among Medicare and 28% among Medicaid enrollees). PLWH with mental health conditions have significantly higher treatment costs for both mental health and non-mental health conditions. Setting managed care capitations that account for these greater expenditures is necessary to preserve access to both mental health and physical health services for PLWH and mental health conditions.

Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana.

BackgroundGhana introduced capitation payment method in 2012 but was faced with resistance from provider groups and civil society organizations for its perceived negative effects on quality care delivery. This study seeks to explore the views of providers to understand their preferred payment method for the various types of services they provide in order to inform the discussion and negotiations during this period of reform. Findings will not only aid the National Health Insurance Authority (NHIA) to improve the implementation arrangements but also provide useful inputs for other low and middle-income countries (LMICs) in their quest to reform their provider payment systems.Materials and methodsWe conducted a cross-sectional survey of 200 credentialed health care providers’ in the three regions of Ghana on providers’ preference for payment method. We administered closed-ended questionnaires employing 5-point Likert scales for measurement of payment method preference. Descriptive and regression analysis were performed to examine healthcare providers’ background characteristics and their association with preferred payment method for primary care.ResultsIn general, health care providers prefer the Ghana-Diagnosis-Related Grouping (G-DRG) payment method to fee-for-service and capitation payment methods. Result of bivariate analyses showed that healthcare providers’ preference for payment method for primary outpatient services differed significantly by their region of residence (p<0.001). The multinomial logic model showed that being a female (p = 0.013) or healthcare provider in the Volta region (p = 0.008) was significantly associated with health provider preference for G-DRG payment method relative to fee-for-service. Similarly, being a healthcare provider in the Volta region (p = 0.026) or Medical Assistant (p = 0.032) was significantly associated with capitation relative to fee-for-service payment method.ConclusionWe conclude that the most preferred payment method across all regions is the G-DRG. However, whereas providers in the Volta region are not willing to accept capitation as payment method, this was not the case in Ashanti and Central regions. Capitation payment method as an option for primary care services in Ghana should, therefore, not be ruled out of the discussion.

What do Iranian general practitioners expect from family physician contracts?

Family medicine has become a main prerequisite of providing primary healthcare and a main reforming strategy to ensure the delivery of efficient and high-quality health services. This study aimed to...

Payment models in primary health care: A driver of the quantity and quality of medical laboratory utilization.

Physician payment models' incentives regarding many aspects of primary health care are not well understood. We focus on the case of medical laboratory utilization and examine how physicians' laboratory test ordering patterns change following a switch to a blended capitation payment model from one with fee for service enhanced with pay for performance. Also, within blended capitation, we examine differences between traditional staffing and interdisciplinary teams. Using a propensity score weighted fixed-effects specification to address selection, it is estimated that the switch to capitation leads to a short-run average of 3% fewer laboratory requisitions per patient. Patients' laboratory utilization also becomes more concentrated with the rostering physician. More importantly, using diabetes-related laboratory tests as a case study, after joining the blended model, physicians order 3% fewer inappropriate/redundant tests, and the addition of an interdisciplinary care team makes the reduction about 9%. Advances in both continuity and quality seem to be associated with blended capitation.

Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling

In 2013, Oregon initiated an Alternative Payment Methodology (APM) Experiment for select health centers, initiating capitated payments for patients with Medicaid. To use electronic health record data to evaluate the impact of APM on visit and scheduling metrics in the first wave of experiment clinics. Retrospective clinic cohort. Difference-in-differences analysis using generalized linear mixed modeling across 2 time thresholds: the initiation of APM and the start of the Affordable Care Act Medicaid expansion. Eight primary clinics enrolled in APM on March 1, 2013 and 10 comparison clinics not enrolled in APM during the study period (July 1, 2012 to February 28, 2015). Independent variable: intervention status of the clinics (APM or comparison). Dependent variables: total patient encounters, total alternative encounters, new patient visits, provider appointment availability, number of appointment overbooks and no-shows/late cancellations. Comparison clinics had smaller patient panels and more advanced practice providers than APM clinics, but both had similar proportions of Hispanic, Medicaid, and uninsured patients. APM clinics had a 20% greater increase in same-day openings than non-APM clinics across the APM implementation (Relative Ratio, 1.20; 95% CI, 1.02 to 1.42). Otherwise, there were minimal differences in APM clinics and control clinics in wait times, visit rates, patient no-shows, and overbooks. APM clinics experienced a greater increase in same-day visits over the course of this experiment, but did not significantly differ from comparators in other visit metrics. Further research into other impacts of this experiment are necessary and ongoing.

Implementing Practice Changes in Family Medicine to Enhance Care and Prevent Disease Progression

This issue epitomizes family medicine with a heavy emphasis on research to prevent illness and illness progression. Which patients will experience significant symptomatic knee osteoarthritis? Do the elderly use retail clinics, and what is the impact on care for chronic conditions? Does capitation payment enhance or decrease same-day access? How do primary care practices risk stratify to provide integrated care? Can risk screening and on-site providers enhance psychiatric care? What screening questions should we ask adolescents, to identify problematic drug use? A report on a practice intervention to improve opioid prescribing practices, and another on the significant level of depression in many patients taking opioid medications. Which works better for smoking cessation-e-cigarettes or nicotine gum? Reminders about teratogenic drugs and those that cause hyperpigmentation. Interdisciplinary care with pharmacists in the office does not help just the patients. We have several articles on diabetes-early diagnosis, and consideration of screening for prediabetes as a quality standard-with added commentaries about this possibility.

Policy Flight Simulators: Accelerating Decisions to Adopt Evidence-Based Health Interventions.

In this study, the authors used simulation to explore factors that might influence hospitals' decisions to adopt evidence-based interventions. Specifically, they developed a simulation model to examine the extent to which hospitals would benefit economically from the transitional care model (TCM). The TCM is designed to transition high-risk older adults from hospitals back to communities using interventions focused on preventing readmissions.The authors used qualitative methods to identify and validate simulation facets. Four simulation experiments explored the economic impact of the TCM on more than 3,000 U.S. hospitals: (1) magnitude of readmission penalty, (2) application to specific diagnosis-related groups, (3) level of cost sharing between payer and provider, and (4) capitated versus fee-for-service payments. The simulator projected hospital-specific economic effects. The authors used Monte Carlo methods for the simulations, which were parameterized with public data sets from the Centers for Medicare & Medicaid Services (CMS) and TCM data from randomized controlled trials and comparative effectiveness studies.Under current conditions, the simulation indicated that only 10 of more than 3,000 Medicare-certified hospitals would benefit financially from the TCM. If current readmission penalties were doubled, the number of hospitals projected to benefit would increase to 300. Targeting selected diagnosis cohorts would also increase the number of hospitals to 300. If payers reimbursed providers for 100% of the TCM costs, 2,000 hospitals would benefit financially. Under a capitated payment model, 1,500 hospitals would benefit from the TCM.Current CMS penalties-or reasonable increases-have little economic effect on the TCM. In the current environment, two strategies are likely to facilitate adoption: (1) persuading payers to reimburse TCM costs and (2) focusing on hospitals with higher bed occupancies and higher revenue patients.

Physician behavior and conditional altruism: the effects of payment system and uncertain health benefit

This paper experimentally investigates the altruistic behavior of physicians and whether this behavior is affected by payment system and uncertainty in health outcome. Subjects in the experiment take on the role of physicians and decide on the provision of medical care for different types of patients, who are identical in all respects other than the degree to which a given level of medical treatment affects their health. We investigate physician altruism from the perspective of ethical principles, by categorizing physicians according to how well their treatment decisions align with different principles for priority setting. The experiment shows that many physicians are altruistic toward their patients but also that the degree of altruism varies across patients with different medical needs. We find a strong effect of payment system that is overall unaffected by the introduction of risk and ambiguity in patients’ health outcomes. There is, however, substantial heterogeneity across individuals, in particular under the capitation payment system where physicians’ responses to the introduction of uncertainty in patient health are modulated by their own generic risk and ambiguity preferences.

Trends in e-visit adoption among U.S. office-based physicians: Evidence from the 2011–2015 NAMCS

BackgroundElectronic visits (e-visits) have the potential to expand patients’ access to care and reduce healthcare costs. We aimed to describe trends in e-visit adoption among the U.S. office-based physicians and examine physician-and practice-level factors associated with e-visit adoption. MethodsThis was a retrospective observational study of 2011–2015 National Ambulatory Medical Care Survey. We used the Cochran-Armitage tests to evaluate trend changes in e-visit adoption among the U.S. office-based physicians. Multivariable logistic regression was used to calculate the odds of adopting e-visits adjusting for physician and practice characteristics. ResultsOur sample included 10,767 respondents, representing 327,836 office-based physicians in the U.S. Our analysis indicated that, in 2015, 15.9% of physicians adopted e-visits, which is a minor increase of 2.2% in total utilization of 13.7% in 2011. The likelihood of adopting e-visits was 2.7 times higher for physicians who have fully implemented electronic health records systems compared (odds ratio, 2.66, [95% CI, 2.16–3.28]) to physicians who have not implemented EHRs. Other predictors of e-visit adoption included primary care rather than specialty care, capitated payment model, and having a secure messaging capability. ConclusionsOur study demonstrates that overall e-visit adoption is low and has not been implemented as rapidly as other health information technologies. While use of secure information technology could be a facilitator for e-visit implementation, there are other barriers affecting widespread adoption. E-visits are a promising strategy for increasing patients’ access to care. Future research is needed to explore implementation barriers that might be impeding e-visit adoption.

Who is driving change, and where is it taking us? Interview with an expert.

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Taking care of high-need patients in capitation-based payment schemes – an experimental investigation into the importance of market conditions

ABSTRACTMany health-care systems use provider payment as an instrument to ensure an efficient and equitable delivery of care. Capitation-based payment schemes are popular because they contain costs. However, they are known to lead to underprovision of care, especially to high-need patients. Using a laboratory experiment, we test whether the availability of resources affects providers’ response to a capitation-based scheme. We find that the relative underprovision of care to high-need patients exists both when providers are resource abundant and constrained. Next, we introduce two different versions of the scheme and test whether they incentivize providers to take better care of high-need patients. One scheme ring-fences part of the capitation payment to a fixed physician salary, whilst the other scheme differentiates payments based on patients’ expected need of care. We find that high-need patients gain the most from a fixed provider salary under resource abundance, but find no difference in gains between patient types under resource constraint. Our results also show that differentiation of capitation makes providers take relatively better care of patients linked to an above average payment compared to a below average payment, regardless of resource constraints. Our findings suggest that both the design of the scheme and the market condition affect providers’ patient prioritization under capitation.

Case analysis and enlightenment of capitation payment system reform

Objective To analyze the main practices of capitation payment system reform in the case areas and put forward enlightenments and suggestions in this regard. Methods The implementation practices of the case areas were summarized, and descriptive statistical analysis was carried out on the implementation effects. Results By analyzing the effectiveness of the case areas′ reform, it was found that the case areas are curbing the excessive growth of medical expenses (for example, outpatient fees per visit of Dingyuan county-level hospitals decreased from 245.11 yuan in 2015 to 218.40 yuan in 2017), increasing the actual compensation ratio of residents (for example, the actual compensation ratio of Funan increased from 59.80% in 2015 to 63.28% in 2017), forming a medical treatment pattern within the county (for example, out-of-county compensation ratio in Dingyuan decreased from 37.38% in 2015 to 31.13% in 2017), achieving double-way referrals (for example, the number of referrals to superior hospitals of Jimo increased from 98 in 2015 to 328 in 2017), improving the subsidence of quality services, and controlling the risks of medical insurance funds. Conclusions At present, the reform of the case areas has been implemented steadily and achieved results. It is recommended to further improve such aspects as reform coordination, insurance standard setting, incentive mechanism establishment, and leadership to ensure the reform progress. Key words: Capitation payment; Payment system reform; Case analysis; Enlightenment; Cost control

Discussion on capitation payment system reform based on case analysis

Pilot areas have achieved initial success in capitation reform. On the other hand, challenges remain unsolved in terms of practical pathways, change of national medical insurance management system, related measures, incentives and allocative mechanism for implement of the reform. With the concerning on progress, practice, effects and challenges of typical areas, this article established an institutional framework. On such basis, we propose to design and refine a scheme in terms of 5 aspects, namely strengthening the basic medical care packages′ financing, setting contents and standard of the basic medical care packages rationally, establishing effective evaluation system and formulating supporting measures. Key words: Capitation; Payment system reform; Medical insurance; Challenges; Strategies