Patients with chronic disease may be excluded from capitated managed care plans due to higher than average expected costs.
In an attempt to remedy this inequity, one type of risk adjustment technique proposes to set separate capitation rates for certain chronic illnesses, including coronary artery disease (CAD).
Cardiologists, who increasingly are requested to accept capitation, will benefit from understanding the impact of using clinical factors as opposed to using demographic factors to set capitation rates.
Using a 5% national random sample of the 1992 Medicare population, we determined mean annual expenditures and variation in expenditures of individuals with CAD.
We compared the use of 2 demographic factors currently used or capitation rate adjustment (age and gender) with 2 factors not currently used-3-digit International Classification of Disease (ICD-9) code (a measure for severity) and Charlson index (a measure for comorbidity).
Mean annual expenditures for individuals with CAD were more than double mean annual expenditures for the general Medicare population ($6,944 vs $3,247).
Among individuals with CAD, mean expenditures of subgroups defined by both age and gener ranged from $6,205 to $7,724.
In comparison, stratifying by measures of severity and comorbidity identified subgroups with lower and higher mean expenditures, producing a range of $1,702 to $19,959. (...)
Mots-clés Pascal : Cardiopathie coronaire, Paiement, Cardiologie, Médecin, Dépense, Coût, Economie santé, Etats Unis, Amérique du Nord, Amérique, Exploration, Homme, Appareil circulatoire pathologie
Mots-clés Pascal anglais : Coronary heart disease, Payment, Cardiology, Physician, Expenditure, Costs, Health economy, United States, North America, America, Exploration, Human, Cardiovascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0201734
Code Inist : 002B12A03. Création : 16/11/1999.