Incentives and cost containment in primary care physician reimbursement.
The goal of capitation is to place gatekeepers at financial risk for the services the deliver. However, third party payers should provide gatekeepers with some type of protection against random and systematic risk transfer. Gatekeeper physicians' other alternative is to reduce this risk on their own by actively marketing services to healthier individuals and creating barriers to care for their sicker patients. Thus, the proper balance of risk transfer will result in the most cost-efficient, quality gatekeeper networks. However, even with the right balance of risk transfer, capitation may provide incentive for some physicians to withhold necessary services to further increase their profit margins-making quality of care a key concern. Thus, practice guidelines should be developed to ensure quality is not affected. These guidelines afford explicit criteria on how gatekeepers should respond in specific clinical situations.
Hewitt Associates, Newport Beach, CA.
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D002204:Capitation Fee / Q000639:trends; D003363:Cost Control / Q000379:methods; D005251:Fees, Medical / Q000639:trends; D007357:Insurance, Physician Services; D008329:Managed Care Programs / Q000191:economics; D010821:Physicians, Family / Q000191:economics* / Q000592:standards; D012052:Reimbursement, Incentive; D015895:Relative Value Scales; D012306:Risk; D014481:United States