Ambulatory Testing for Capitation and Fee-For-Service Patients in the Same Practice Setting

Previous studies of the impact of varying reimbursement incentives on physician behavior have not explored the simultaneous implications for patients' health outcomes. Using a single group of physicians who provided care for hypertensive patients with either capitation (N = 99) or fee-for-service (N = 66) health insurance plans, physicians' test-ordering behavior and patients' subsequent health outcomes were examined. After controlling for patients' age, severity of hypertension, and level of comorbidity, it was found that patients with capitation health insurance had fewer laboratory tests and lower overall charges than the fee-for-service patients, with no clinical or statistically significant differences in 1-year health outcomes, specifically blood pressure control. The study concludes that capitation can result in reduction in charges associated with management of hypertension, without apparent compromise in proximate health outcomes

Ambulatory · Capitation · Capitation fee · Comorbidity · Family medicine · Fee-for-service · Health care · Reimbursement · Test (biology) · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Internal Medicine · Medicine · Primary Care and Health Outcomes

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