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Being organized as a group/staff HMO generally has a stronger impact on care access and quality than capitation

The group/staff HMO model, in which HMO members see health care providers who are salaried HMO staff, has more impact on care access and quality than provider capitation, in which providers receive a fixed payment from a health plan for each enrollee assigned to them. Samuel H. Zuvekas, Ph.D., and Steven C. Hill, Ph.D., senior economists in the Center for Financing, Access, and Cost Trends at the Agency for Healthcare Research and Quality, found that group/staff HMOs appear to substantially increase office hours but decrease coordination of care.

Drs. Zuvekas and Hill suggest that insurers pay attention to harder to measure quality of care dimensions, such as coordination of care, when designing reimbursement systems. They explain that, relative to other HMOs that capitate, group/staff HMOs may have a greater ability to align incentives, and they also may have more direct control over care.

The effect also may be due to the limited way in which most plans have implemented capitation, with only physician services in the capitation payment and no rewards for quality. Capitation by itself may increase consumers' access to the usual sources of care and improve primary preventive care, but it also may reduce coordination of care. However, more research is needed, caution the researchers. They analyzed data from the Household Component and the Medical Provider Component of the nationally representative Medical Expenditure Panel Survey for 1996 and 1997. They estimated the impact of capitation on care access, quality, and service use for nonelderly, privately insured HMO enrollees' usual source of care.

See "Does capitation matter? Impacts on access, use, and quality," by Drs. Zuvekas and Hill, in the Fall 2004 Inquiry 41, pp. 316-335. Reprints (AHRQ Publication No. 05-R046) are available from the AHRQ Publications Clearinghouse.

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