PEDIATRICS Vol. 77 No. 1 January 1986, pp. 29-34
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gordon, T.
Right arrow Articles by Peterson, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gordon, T.
Right arrow Articles by Peterson, R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Capitation Reimbursement for Pediatric Primary Care

Toby Gordon ScD1, Catherine DeAngelis MD, MPH1, and Ronald Peterson MHA1

1 From the Departments of Anesthesiology and Critical Care Medicine and Pediatrics, The Johns Hopkins Hospital, The Johns Hopkins University; and Francis Scott Key Hospital, Baltimore

A feasibility analysis of capitation reimbursement for a primarily Medicaid population in The Johns Hopkins Pediatric Primary Care Clinic was conducted. The utilization of all inpatient and outpatient care of 2,261 patients was monitored for a 6-month period. As a result, per capita rates based on charges were determined for each group of patients according to type of insurance. Blue Cross and private insurance patients had capitation rates three times that of the Medicaid patients and over ten times that of the self-pay patients. This variation in utilization was attributed to the selection of enrollees, the morbidity of the population, and the varying services covered by payor group. Administrative issues regarding establishing a pediatric health maintenance organization are also discussed. Close supervision of house staff in treating patients, including admissions, length of stay, and specialty referral is of utmost importance in containing costs in this clinic setting.

Key Words: Medicaid • capitation reimbursement • insurance • pediatric health maintenance organization

Submitted on December 10, 1984
Accepted on April 8, 1985


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Arch Intern MedHome page
K. M. McIntyre
Implementation of Advance Directives: For Physicians, a Legal Dilemma Becomes an Ethical Imperative
Arch Intern Med, May 1, 1992; 152(5): 925 - 929.
[Abstract] [PDF]

Home page
 JAMAHome page
P. A. Braveman, S. Egerter, T. Bennett, and J. Showstack
Differences in Hospital Resource Allocation Among Sick Newborns According to Insurance Coverage
JAMA, December 18, 1991; 266(23): 3300 - 3308.
[Abstract] [PDF]