What Is A Medicare Capitation Agreement

As shown in Figures 1 and 2.2, the number of Medicare beneficiaries enrolled in prepaid organizations on at-risk contracts and the number of at-risk contracts increased dramatically between December 31, 1979 (before HMO risk events) and March 31. which, since HCFA`s first experiment with real prepaid per capita work, has intervened in the Medicare Capitation protests, has increased to an increase in the total number of beneficiaries registered in prepaid registrations, to an increase of almost 300% (527,521 registered at 31 December 1979, compared to 1,428,309 registered as of 31 March 1986). If wholesale health plans (which only cover Part B services) are not counted, this figure is even more dramatic – an increase of more than 3,000 per cent. Despite these increases, it is important to keep in mind that the free movement of beneficiaries in prepaid plans is still in its infancy. As of March 31, 1986, the total population of Medicare, Medicare beneficiaries account for about 7.6 percent of the total HMO enrollment. 6 The success of Medicare`s investments in capitation clearly depends on the fact that many beneficiaries decide to enroll in HMO. HOV and prepaid practices are relatively new in many parts of the country and are particularly unusual for retirees who have rarely encountered an HMO option during their years of employment. In addition, older adults can be expected to have closer relationships with health care providers and therefore less likely to join an HMO, even if the benefits and costs are very attractive. For recipients to choose the HMO option, they must consider the HMO option as a filling of a need and HOV must be able to successfully commercialize their plans to recipients. Second, another approach that has recently attracted attention is the direct choice of physician (Pauly and Langwell, 1986; U.S. Congress (OTA), 1986; Langwell and Nelson, 1986), which would cover individual medical groups and/or physicians, to coordinate and receive payments for all benefits for Medicare recipients who decide to participate in the program. A direct physician-head choice would extend capitation to HMO-free areas, or where hMO capacity is significantly reduced. This article describes the history of Medicare`s process contract, the current status and terms of those contracts.

We also discuss capitation issues under the Medicare program, verify and evaluate evidence on these issues, and describe ongoing research that will provide additional evidence on these issues. These themes include: in head systems, at the HMO and, in some cases, among doctors, they face incentives to limit access to services. To the extent that overexploitation of this market is problematic, the reduction in use may be desirable and even lead to higher quality care than has sometimes been provided as part of a pricing service. However, if the incentives are excessive, Medicare recipients may receive inadequate services.

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