Affiliations: [a] Division of Social and Economic Research, Center for
Financing, Access and Cost Trends Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850, USA. Tel.: +1 301 427 1673, +1 301 427
1659; Fax: +1 301 427 1276; E-mail: {szuvekas,jcohen}@ahrq.gov
Correspondence:
[*]
Corresponding author
Abstract: We examine the extent to which the health care services delivered by physicians
and hospitals in public and private health plans are capitated, and how this
changed from 1996 to 2000. The data are from the 1996 to 2000 years of the
nationally representative Medical Expenditure Panel Survey (MEPS). Information
on whether health care use was covered by capitated arrangements was obtained
from billing offices of physicians and hospitals. We compare changes in the
percentage of office-based physician visits, hospital outpatient department
(OPD) visits, hospital emergency department (ED) visits, and hospital inpatient
stays that are covered by capitation arrangements. We also compare differences
by health insurance coverage and socio-demographic characteristics. We use
standard two-tail tests of significance, accounting for the complex survey
design of the MEPS. We find that only 15 percent of visits to office-based
physicians were capitated in 1996, declining to 13 percent in 2000. Even among
HMO enrollees, visits covered by a provider capitation arrangement represented a
minority of all office visits, declining to 25 percent for Private HMO enrollees
and 15 percent for Medicaid HMO enrollees in 2000. Even smaller proportions of
hospital services were capitated. Conclusions: Capitation remains relatively
rare even among public and private HMO enrollees.
