[Impact of a capitation payment system on healthcare coordination].
OBJECTIVE
To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective.


METHODS
An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants' groups, themes, and areas. The study area consisted of the 5 pilot zones.


RESULTS
According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty, providers' fears of losing their identity, lack of interest, and the management limits of some providers.


CONCLUSIONS
The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia.
Vargas Lorenzo
Ingrid
I
Servei d'Estudis i Prospectives en Polítiques de Salut, Consorci Hospitalari de Catalunya, Barcelona, España.
Vázquez Navarrete
M Luisa
ML
Terraza Núñez
Rebeca
R
Agustí
Enric
E
Brosa
Francesc
F
Casas
Carme
C
D002204:Capitation Fee; D003695:Delivery of Health Care / Q000458:organization & administration*; D012051:Reimbursement Mechanisms; D013030:Spain