Variations in Physician Utilization Patterns in a Capitation Payment IPA-HMO

Burkett, Gary L.

doi:10.1097/00005650-198211000-00007

Cited by 11 publications

(2 citation statements)

References 15 publications

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“…These institutions receive capitation payments but generally pay member physicians on a fee-for-service basis. Neither the foundations nor the IPAs have conclusively shown themselves to be less expensive than pure fee-for-service practices (Holahan 1977;Burkett 1982). IPA-HMOs have reduced hospitalization rates (though less than group practice HMOs), but they may have higher ambulatory utilization rates than either group practice HMOs or fee-for-service settings (Hombrook and Berki 1985).…”

Section: In the United Statesmentioning

confidence: 99%

Payment Mechanisms under a National Health Program

Bodenheimer

1989

Medical Care Review

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future time to extend the number of countries studied to determine if the conclusions reached here can be confirmed.The article begins with a discussion of who should pay hospitals and doctors and a subsequent exploration of the various modes of payment-first for hospitals, then for physicians. Thereafter, the article proceeds to brief examinations of two specific topics, patient cost sharing and closed-panel (HMO) enrollment. The conclusion proposes specific policies for paying hospitals and doctors under an American national health program.

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Section: In the United Statesmentioning

confidence: 99%

Payment Mechanisms under a National Health Program

Bodenheimer

1989

Medical Care Review

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“…If the IPA generates only 5 or 10 percent of his income, the physician is less likely to respond to financial incentives or to be a serious participant in utilization review of his colleagues than if 30 percent of his income depends on the IPA's ability to control its costs (cf. Burkett 1982). As recently as 1983, Brown stated that IPA physicians "usually devote only a small fraction of their practices to prepaid patients.…”

Section: Ipa Structurementioning

confidence: 99%

The New Structure of Individual Practice Associations

Welch¹

1987

Journal of Health Politics, Policy and Law

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There are two types of HMOs: prepaid group practices (PGPs) and individual practice associations (IPAs). Because of rapid change in the HMO industry, the academic literature, which is based primarily on data from the 1970s, is dated in several ways. The literature has focused on PGPs, but IPAs are growing three times faster than PGPs and are likely to dominate the HMO industry in the near future. The literature indicates that a small proportion of an IPA physician's practice is capitated, but such practices often are as much as one-third capitated. And while the literature indicates that IPA physicians are rarely given financial incentives to control cost, such incentives are now common. In this decade IPAs have cut their hospital days per thousand enrollees. Furthermore, IPAs in which individual physicians or medical groups bear some of the financial risk of hospital costs appear to have the same rate of hospital days as PGPs. Additional research is especially needed on cost and quality of care in modern IPAs.

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Comparison of Critical Care Provided by Family Physicians and General Internists

Hainer

Lawler²

1988

JAMA

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Privilege conflicts and credentialing issues involving family physicians' care of hospitalized patients are controversial areas. This study compares the process and outcome of critical care provided by family physicians and general internists. We studied 523 patients admitted by these specialists to the medical intensive and cardiac care units of a large regional hospital over a one-year period. The length of stay and readmission rate in the intensive care unit and hospital, severity of illness, discharge diagnosis, proportion who died, time until death of those who died, consultation rate, and hospital charges did not differ significantly between patients cared for by physicians in the two specialties. Application of Cox's proportional hazard model to the data indicated the risk of death to be significantly related to patient race, age, and severity of illness, but not to physician specialty. Regression analysis of several morbidity variables showed no relationship to physician specialty. Lack of differences in outcome and process in the hospital studied leads us to believe that both family physicians and general internists are entitled to have equal access to the care of patients in critical care units.

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Variations in Physician Utilization Patterns in a Capitation Payment IPA-HMO

Cited by 11 publications

References 15 publications

Payment Mechanisms under a National Health Program

Payment Mechanisms under a National Health Program

The New Structure of Individual Practice Associations

Comparison of Critical Care Provided by Family Physicians and General Internists

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