Setting payment rates for capitated systems: a comparison of various alternatives. Inquiry 1990;27(3):225-33
Date
01/01/1990Pubmed ID
2145223Scopus ID
2-s2.0-0025084081 (requires institutional sign-in at Scopus site) 39 CitationsAbstract
Numerous proposals have been suggested to revise the current adjusted annual per capita cost (AAPCC) method for paying HMOs in the Medicare program. Several evaluations of the various alternatives conclude that including a prior utilization variable is the most promising alternative. In this paper, using statistical and other criteria, we compare the current AAPCC method with three different prior utilization models. The results suggest that all three prior utilization models can predict expenditures for either individuals or a group--drawn from a cross section and a risk selected sample of aged Medicare beneficiaries--more accurately than the AAPCC method. Of the three prior utilization measures, Payment Amount for Capitated Systems (PACS) predicts actual expenditures most accurately.
Author List
Anderson GF, Steinberg EP, Powe NR, Antebi S, Whittle J, Horn S, Herbert RAuthor
Jeffrey Whittle MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Capitation FeeCluster Analysis
Costs and Cost Analysis
Diagnosis-Related Groups
Health Maintenance Organizations
Medicare
Models, Theoretical
Rate Setting and Review
United States
