Risk-adjusted capitation: The Israeli experience

the experience of risk-adjusted capitation payment for family physicians in iran: a qualitative study

conclusions with regard to the current challenges in iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. however, future research should focus on the development of the risk-adjusted capitation model. background when a country’s health system is faced with fundamental flaws that require the redes...

The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study

BACKGROUND When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. OBJECTIVES This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC)...

Risk-adjusted capitation: recent experiences in The Netherlands.

The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch...

Medicare Risk-Adjusted Capitation Payments: From Research to Implementation

Risk-Adjusted Medicare Capitation Rates Using Ambulatory and Inpatient Diagnoses

Researchers at The Johns Hopkins University (JHU) developed two new diagnosis-oriented methodologies for setting risk adjusted capitation rates for managed care plans contracting with Medicare. These adjusters predict the future medical expenditures of aged Medicare enrollees based on demographic factors and diagnostic information. The models use the Ambulatory Care Group (ACG) algorithm to cat...