An analysis of capitation rates for prescription medication benefits from an insurance perspective.
The use of capitation payment systems to control costs for prescription medication benefits appears to be increasing. In such a system, risk is transferred to a pharmacist or group of pharmacists. The author examines the nature of that risk, factors that must be considered in setting capitation rates and ways to control risk in a capitation system. An insurance pricing model is used to calculate risk-adjusted capitation rates using observed and hypothetical data, and implications for pharmacists and insurers are discussed.
Lawson
K A
KA
University of Texas at Austin.
D002204:Capitation Fee / Q000458:organization & administration*; D003363:Cost Control / Q000379:methods*; D017049:Employer Health Costs; D005252:Fees, Pharmaceutical; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D015233:Models, Statistical; D011907:Rate Setting and Review / Q000379:methods; D012051:Reimbursement Mechanisms / Q000191:economics; D012308:Risk Management / Q000191:economics / Q000379:methods; D014481:United States