There has been a lot analysis displaying that fee-for-service (FFS) results in elevated provision of medical providers and capitation results in decreased provision of medical providers. My personal analysis exhibits that there are system-wide results and that the impression of capitation for main care physicians on providers could rely upon whether or not specialists are additionally reimbursed through fee-for-service. However, it’s not clear how rising the proportion of reimbursement that’s capitated impacts well being care service provision. This is a crucial for quite a few causes. First, CMS is more and more shifting to different fee fashions which might be trying increasingly more like capitation. Second, a big share of well being care provision within the US is underneath combined reimbursement schemes. Third, reimbursement sort varies throughout nations; or occasion, in in Norway and Denmark, FFS accounts for 70%–80% of the full reimbursement however within the household well being group scheme in Ontario, Canada, FFS half covers solely 10% of reimbursement.
To study this query, a paper by Skovsgaard et al. (2023) makes use of a change to normal practitioner reimbursement in Denmark 2018, particularly for treating sufferers with Type 2 diabetes. The particular adjustments have been as follows:
The new lump-sum capitation for sufferers with sort 2 diabetes was set at DKK 2045 (approx. US$ 280) per affected person per yr along with the fundamental lump-sum capitation per affected person. This quantity was increased than the corresponding common FFS which have been discontinued for sufferers with sort 2 diabetes. Notice that the capitation changed FFS for all contacts for sufferers with sort 2 diabetes, not solely contacts associated to diabetes. The remaining FFS charges outdoors the reform comprise a variety of supplementary providers together with guideline-recommended monitoring of HbA1c, influenza vaccination and assessments for microalbuminuria by assessing protein in urine. These guideline-recommended providers are course of high quality measures which point out if adjustments in service provision impacts high quality of care
https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4736
In phrases of empirical technique, the authors carry out a distinction in-difference strategy. The pre-post is variations between the outcomes and curiosity earlier than and after an annual management go to. The change in providers is examined for annual management visits in 2018-2019 as in comparison with 2015-2016. The outcomes or curiosity have been: (i) variety of visits (in-person, telephone and e mail), (ii) variety of diabetes-related lab assessments (e.g., urine sticks, and HbA1c assessments), (iii) flu vaccinations, (iv) supplemental providers associated to diabetes, and (v) supplemental providers not associated to diabetes.
Using this strategy, authors discover that:
The impact of enrolling a affected person within the new scheme is detrimental with a discount of round 2% as in comparison with the baseline worth (ATT = −0.27%; −1.9%)…the impact of enrollment on supplementary providers (s) associated to diabetes pointers is detrimental at a magnitude of round 4% discount as in comparison with baseline (ATT = −12.29%; −4.4%)…The outcomes [also] point out reductions 5.0%, 5.4%, and 4.2% as in comparison with baseline for urine sticks, blood pattern, and affect vaccination, respectively.
To confirm the robustness of their findings, the authors checked out providers not included within the new reimbursement scheme (e.g., lipid reducing medicines) and located no impact for this placebo take a look at.
The authors hypothesize that the explanation the reductions in supplemental providers have been bigger in magnitude than the discount in visits was due to a substitution away from face-to-face visits towards telephone and e mail contacts that do now enable for fast provision of supplemental providers.
You can learn the complete paper right here.