title: Half-Managed Care: A Preliminary Assessment of a Capitation Program in a Health Care System Without Gatekeepers.
abstract: In 2011, a novel capitation program was launched in Taiwan under its universal health insurance plan. This study aimed to assess the short-term impact of the program. Two hospitals in the greater Taipei area, one participating in the "loyal patient" model (13,319 enrollees) and one in the "regional resident" model (13,768 enrollees), were analyzed. Two comparison groups were selected by propensity score matching. Generalized estimating equation models with differences-in-differences analysis were used to examine the net effects of the capitation program on health care utilization, expenses, and outcomes. Enrollees in the loyal patient model had fewer physician visits in the host hospital, but more physician visits outside that hospital during the program year than they had the year before. Compared with non-enrollees, the loyal patient model enrollees incurred fewer physician visits (β = -0.042, p < .001), fewer emergency department visits, (β = -0.140, p < .001), and similar total expenses and outcome. For the regional resident model, no differences were found in the number of physician visits, expenses, or outcomes between enrollees and non-enrollees. The novel capitation models in Taiwan had minimal impact on health care utilization after 1 year of implementation and the health care outcome was not compromised.
authors.affiliation: 1 Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Shou-Hsia
authors.initials: SH
authors.lastname: Cheng
authors.affiliation: 2 National Health Insurance Administration, Taipei Division, Ministry of Health and Welfare, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Chang
authors.affiliation: 3 Department of Public Health, College of Medicine, Fen-Jen Catholic University, Taiwan.
authors.forename: Chi-Chen
authors.initials: CC
authors.lastname: Chen
authors.affiliation: 4 Department of Family Medicine, National Taiwan University Hospital Jin-Shan Branch, Taipei, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Shih
authors.affiliation: 5 National Health Insurance Administration, Ministry of Health and Welfare, Taiwan.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002204:Capitation Fee; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000639:trends*; D008875:Middle Aged; D009936:Organizational Innovation; D057216:Propensity Score; D013624:Taiwan; D019472:Universal Health Insurance / Q000191:economics*
keywords: Taiwan; assessment; capitation payment; healthcare expenses; healthcare outcomes; healthcare utilization