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Capitation Payment for Pharmacy ServicesII. Impact on Costs

 

作者: Charles Yesalis,   G Joseph Norwood,   Dennis Helling,   David Lipson,   R J Mahrenholz,   Leon Burmeister,   Mark Jones,   Wayne Fisher,  

 

期刊: Medical Care  (OVID Available online 1984)
卷期: Volume 22, issue 8  

页码: 746-754

 

ISSN:0025-7079

 

年代: 1984

 

出版商: OVID

 

关键词: Medicaid;pharmacy;drug utilization;financing;capitation;reimbursement;quality assessment

 

数据来源: OVID

 

摘要:

Four areas of cost were analyzed in the expanded capitation drug program: total program costs; drug costs, escrow account distribution, and administrative costs. Total program costs were, on average, 9% higher under capitation. Drug costs, however, were 3% lower than under fee-for-service (FFS) reimbursement. This discrepancy is probably because pharmacists were not at financial risk under the program, the capitation rates were higher than intended, there were many emergency claims, and other aspects of the research environment. Although administrative costs were large, almost two thirds of the development cost was for one-time work, which could be transferred to another state at little or no expense. One third of the total administrative costs can be attributed to complying with regulations of the Health Care Financing Administration. Significant refinement of the present capitation model may be necessary before this financing innovation is used elsewhere. Modifications might include limiting the system to nursing home patients, placing pharmacists at partial financial risk, restricting participation to pharmacies that service a large number of Medicaid eligibles, and basing capitation rates in part on the drug use behavior of cashpaying patients.

 

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