Capitation Agreement Medicare

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As part of a capitation agreement, a list of specific inclusion services must be made available to patients in the contract. When the family physician signs a capitation agreement, a list of specific services to be provided to patients is included in the contract. The amount of capital is determined in part by the number of services provided and varies from one health plan to another, but most capital plans for basic care services include: the HCFA Research and Demonstration Office has sponsored a series of studies on issues related to the effects of capitation, which provides information to definitively determine the nature of the Medicare program`s policy of delivery. It should be noted that the President`s Council on Domestic Policy recommended that the Department of Health and Human Services (DHHS) test and implement a comprehensive capitulation system that expands the current Medicare HMO program to allow for surrenders to other insurers and medical groups. The quality of care in dimpling systems is also an issue, as doctors are financially incentivized to provide fewer services. There is little evidence that there are differences in quality for the population under 65 that participates in HMOs. However, the Medicare population is more vulnerable to quality defects and the finding that capitation may offer lower costs, but quality health care, is a priority for HCFAs. An HCFA study on the quality of supply to Medicare HMOs is currently underway and the results are expected to be available in mid-1987. Although the Medicare program has been studying capitation alternatives for nearly a decade, many problems remain to be solved.

In this section, we highlight (1) HCFA demonstration programs aimed at broadening and refining risk contracture (2) describe ongoing research that would provide answers to many of these questions; and (3) to discuss the direction of the future capital policy for the Medicare programme and to highlight several problems related to these new directions. Second, another approach that has recently attracted attention is direct medical captaincy (Pauly and Langwell, 1986; ==.

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