Untitled

Abstract

Primary medical care capitation payments adjusted only for age and sex do not reflect the relative health care needs of enrolled practice populations. Our alternative formulae based on socioeconomic and mortality data also failed to reflect relative needs. Methods that use other approaches to adjusting for differences in relative need among enrolled populations should be investigated.

Using Diagnoses to Estimate Health Care Cost Risk in Canada

“…The weak performance of the demographic model is a concern for the Ontario health system, and one that echoes prior research showing that neither age and sex nor socioeconomic and mortality data were adequate for needs-based capitation 20. Currently, physicians participating in capitated payment plans receive prospective payments based solely on the age-sex composition of their patient panels.…”