Physician Earnings at Risk: An Examination of Capitated Contracts

Health Affairs

Volumn 16, Issue 3, 1997, Pages 120-126

  Simon, Carol J ^a   Emmons, David W ^b  

^a UNIVERSITY OF ILLINOIS AT CHICAGO   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAPITATION FEE; ECONOMICS; FINANCIAL MANAGEMENT; HEALTH INSURANCE; HUMAN; MEDICAL FEE; PHYSICIAN; RISK; SALARY AND FRINGE BENEFIT; STATISTICS; UNITED STATES;

CAPITATION FEE; CONTRACT SERVICES; FEE-FOR-SERVICE PLANS; HUMANS; MANAGED CARE PROGRAMS; PHYSICIANS; RISK; SALARIES AND FRINGE BENEFITS; UNITED STATES;

EID: 0347799670     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.3.120     Document Type: Review

References (21)

1. Congressional Budget Office, "The Effects of Managed Care and Managed Competition," CBO Memorandum (Washington: CBO, 1995); R.H. Miller and H.S. Luft, "Managed Care Plan Performance since 1980: A Literature Analysis," Journal of the American Medical Association (18 May 1994): 1512-1519; and A.C. Enthoven, "Why Managed Care Has Failed to Contain Costs," Health Affairs (Fall 1993): 27-43.
2. Congressional Budget Office, "The Effects of Managed Care and Managed Competition," CBO Memorandum (Washington: CBO, 1995); R.H. Miller and H.S. Luft, "Managed Care Plan Performance since 1980: A Literature Analysis," Journal of the American Medical Association (18 May 1994): 1512-1519; and A.C. Enthoven, "Why Managed Care Has Failed to Contain Costs," Health Affairs (Fall 1993): 27-43.
3. Congressional Budget Office, "The Effects of Managed Care and Managed Competition," CBO Memorandum (Washington: CBO, 1995); R.H. Miller and H.S. Luft, "Managed Care Plan Performance since 1980: A Literature Analysis," Journal of the American Medical Association (18 May 1994): 1512-1519; and A.C. Enthoven, "Why Managed Care Has Failed to Contain Costs," Health Affairs (Fall 1993): 27-43.
4. D.W. Emmons and C.J. Simon, "Managed Care: Participation, Revenues, and Risk," Socioeconomic Characteristics of Medical Practice, ed. M. Gonzalez (Chicago: American Medical Association, 1995).
5. M. Gold et al., "A National Survey of the Arrangements Managed-Care Plans Make with Physicians," The New England Journal of Medicine (21 December 1995): 1678-1683; M. Gold et al., "Behind the Curve: A Critical Assessment of How Little Is Known about Arrangements between Managed Care Plans and Physicians," Medical Care Research and Review 52, no. 3 (1995): 307-341; and J.C. Robinson and L.P. Casalino, "The Growth of Medical Groups Paid through Capitation in California," The New England Journal of Medicine (21 December 1995): 1684-1687.
6. M. Gold et al., "A National Survey of the Arrangements Managed-Care Plans Make with Physicians," The New England Journal of Medicine (21 December 1995): 1678-1683; M. Gold et al., "Behind the Curve: A Critical Assessment of How Little Is Known about Arrangements between Managed Care Plans and Physicians," Medical Care Research and Review 52, no. 3 (1995): 307-341; and J.C. Robinson and L.P. Casalino, "The Growth of Medical Groups Paid through Capitation in California," The New England Journal of Medicine (21 December 1995): 1684-1687.
7. M. Gold et al., "A National Survey of the Arrangements Managed-Care Plans Make with Physicians," The New England Journal of Medicine (21 December 1995): 1678-1683; M. Gold et al., "Behind the Curve: A Critical Assessment of How Little Is Known about Arrangements between Managed Care Plans and Physicians," Medical Care Research and Review 52, no. 3 (1995): 307-341; and J.C. Robinson and L.P. Casalino, "The Growth of Medical Groups Paid through Capitation in California," The New England Journal of Medicine (21 December 1995): 1684-1687.
8. Gold et al., "Behind the Curve."
9. Hoechst Marion Roussel, Managed Care Digest (Kansas City, Mo.: Hoechst Marion Roussel, 1996).
10. J. Christianson et al., "Managed Care in the Twin Cities: What Can We Learn?" Health Affairs (Summer 1995): 114-130.
11. G.S. Meyer and D. Blumenthal, "TennCare and Academic Medical Centers: The Lessons from Tennessee," Journal of the American Medical Association (4 September 1996): 672-682.
12. The AMA recognizes obstetricians and gynecologists as primary care physicians. We categorize them here as specialists because their contracting patterns are empirically closer to those of specialists than to those of primary care physicians.
13. P. Havlicek, ed., Physician Groups in the U.S. (Chicago: American Medical Association, 1996); and D.W. Emmons and P.R. Kletke, "Physician Practice Size, 1991-1995," in Organization and Management of Physician Services, ed. R. Conners (forthcoming).
14. P. Havlicek, ed., Physician Groups in the U.S. (Chicago: American Medical Association, 1996); and D.W. Emmons and P.R. Kletke, "Physician Practice Size, 1991-1995," in Organization and Management of Physician Services, ed. R. Conners (forthcoming).
15. Physicians in small practices are generally more likely to be able to answer questions about managed care contracts and practice finances. Item nonresponse rates for the managed care questions are 2-9 percent for solo practices and 7-14 percent for practices with 51+ physicians. Differences in response rates, however, are not statistically significant except when comparing the smallest groups with the 51+ physician groups.
16. J.E. Kralewski et al., "The Effects of Capitation Payment on the Organizational Structure of Medical Group Practices," Journal of Ambulatory Care Management 19, no. 1 (1996): 1-16.
17. K. Swartz and T.A. Brennan, "Integrated Health Care, Capitated Payment, and Quality: The Role of Regulation," Annals of Internal Medicine (15 February 1995): 442-448; and S. Woolhandler and D. Himmelstein, "Extreme Risk - The New Corporate Proposition for Physicians," The New England Journal of Medicine (21 December 1995): 1706-1708.
18. K. Swartz and T.A. Brennan, "Integrated Health Care, Capitated Payment, and Quality: The Role of Regulation," Annals of Internal Medicine (15 February 1995): 442-448; and S. Woolhandler and D. Himmelstein, "Extreme Risk - The New Corporate Proposition for Physicians," The New England Journal of Medicine (21 December 1995): 1706-1708.
19. E.A. Kerr et al., "Managed Care and Capitation in California: How Do Physicians at Financial Risk Control Their Own Utilization?" Annals of Internal Medicine (1 October 1995): 500-504.
20. F.J. Hellinger, "The Impact of Financial Incentives on Physician Behavior in Managed Care Plans: A Review of the Evidence," Medical Care Research and Review 53, no. 3 (1996): 294-314; and Woolhandler and Himmelstein, "Extreme Risk."
21. F.J. Hellinger, "The Impact of Financial Incentives on Physician Behavior in Managed Care Plans: A Review of the Evidence," Medical Care Research and Review 53, no. 3 (1996): 294-314; and Woolhandler and Himmelstein, "Extreme Risk."