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Capitation among Medicare beneficiaries
1Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH, USA.
Effective Clinical Practice : ECP
|May 27, 1999
Summary
Medicare capitation, a cost-containment strategy, shows significant regional and urban concentration. Beneficiary enrollment varies widely, with higher rates in Western states and major metropolitan areas.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- The Medicare program utilizes capitation payment models to control healthcare expenditures.
- Approximately 15% of Medicare beneficiaries are enrolled in capitation plans, exhibiting substantial geographic disparities.
Purpose of the Study:
- To analyze the geographic distribution and market penetration of Medicare capitation plans.
- To identify regional and metropolitan variations in beneficiary enrollment in risk-contract plans.
Main Methods:
- Examined the proportion of Medicare beneficiaries enrolled in risk-contract plans.
- Data analyzed at the state and top 25 metropolitan area levels.
- Utilized Health Care Financing Administration (HCFA) data files.
Main Results:
- Arizona (38%) and California (37%) lead in Medicare capitation rates.
- Eight additional states exceed 20% capitation; 30 states remain below 10%.
- Four metropolitan areas (San Bernardino, San Diego, Phoenix, Miami) show over 40% penetration; urban areas dominate enrollment.
Conclusions:
- Medicare capitation is predominantly a regional phenomenon.
- Enrollment in capitation plans is significantly concentrated in urban settings.
- Geographic and urban-rural disparities characterize Medicare capitation.