A one-year experience with a capitated health care plan for infertility.
OBJECTIVE
To report on a one-year experience participating in a capitated healthcare plan for infertility.


METHODS
Prospective study.


METHODS
University population.


METHODS
Reproductive-age women 15 to 50 years.


METHODS
The first-generation Lewin infertility algorithm and CATHI software were used to negotiate infertility services under a capitated arrangement for $0.50 per member per month. The following reports our experience for the fiscal year 1997.


METHODS
Infertility services rendered, pregnancy rate, cost of services, collection rates.


RESULTS
Five thousand forty-six women representing 39,689 member months generated 39 new and 198 return visits. Thirty-two percent of the patients required three visits or less; six patients generated 22% of the visits. Fifty-one percent listed infertility as one of their chief complaints; 31% had mixed diagnoses. Eight (7.6%) patients required surgery, 11 (10.5%) patients underwent either IVF or GIFT cycles. Total charges submitted were $176,636; the amount assigned to specialty care was $135,277, and to IVF/GIFT, $33,433. Total capitated payments, including copayments, was $126,256 under the reproductive medicine agreement and $32,891 under the infertility rider. This resulted in a 71% gross collections rate.


CONCLUSIONS
This study indicates that entering into a capitated health care plan to provide an infertility benefit can produce a successful result.
Blackwell
R E
RE
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama 35223, USA. rblackwe@uabmc.edu
Hammond
K R
KR
Steinkampf
M P
MP
D000293:Adolescent; D000328:Adult; D000407:Alabama; D000465:Algorithms; D003284:Contract Services; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics / Q000706:statistics & numerical data; D015181:Gamete Intrafallopian Transfer / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007247:Infertility, Female / Q000191:economics / Q000628:therapy*; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics; D011446:Prospective Studies; D012051:Reimbursement Mechanisms; D012984:Software; D013997:Time Factors