Pre-paid, or capitated payments to health care providers change incentives for treatment, and are widely used in a variety of settings including global budgets and ACO models. Certain forms of capitated payments, such as case-rate payments, create incentives to change both diagnosis and treatment patterns that may differ from both fee-for-service and pure capitated models. The purpose of this study is to examine the changes in severity determination and service use associated with changes in case-rate payments used to pay for publicly-funded mental healthcare. We model provider-assigned severity categories as a function of category-specific capitated payments using conditional logit regressions and counts of service days per month using hurdle models. We find that severitydetermination is only weakly associated with price but that level of use shows a greater degree of association; these results vary between the early or “transition” period immediately after implementation to the subsequent period, 2-4 years after implementation.
Marisa Domino, Ph.D., is a Professor of Health Economics in the Department of Health Policy and Management at the University of North Carolina at Chapel Hill. She received her Ph.D. in Health Economics from the Johns Hopkins University and completed a Postdoctoral Fellowship in the economics of mental health at Harvard Medical School’s Department of Health Care Policy. Dr. Domino’s research interests include the economics of mental health, agency relationships among physicians, patients and insurers, the diffusion of new technologies, and the public provision of health care and health insurance to low income populations. She is working on a number of projects evaluating innovations in clinical practice, including examining the incentives of medical homes on persons with chronic illnesses, and drug-based registries for children on antipsychotic medications.
This seminar is free and open to the public, RSVP is not required.
Co-sponsored by the Department of Health Policy & Management, School of Public Health, U of MN
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