The Massachussetts health plan has been successful by some metrics--the recorded number of the uninsured has gone down--and unsuccessful on others.Well, I'll be, the primary goal of a program has been achieved, although other imperfections in this still new and seminal initiative have yet to be worked out.
Sounds horrible.
Also, I agree with her, capitation is idiotic.
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Most of the overage came from an initial severe underestimation of the number of uninsured.
Not so convinced re: capitation. Given the choice between that an Fee for Service, the former is more likely to control costs. (Which is probably why McMegan opposes it; it may limit a doctor's income.)
Otoh, we've always heard about how doctors order extra work or encourage additional procedures when they are compensated on a FFS basis, but I don't think I've ever seen empirical results that indicate that. (After all, the add-on work is additional work the doctor would have to do, which would imply that s/he has 'free time.')
What occasionally happens under capitation is that doctors do their in-network work and arrange "private practice days," as it were, outside of insurance bounds.
But that would be capitalism at work, which should be another point in favor of capitation.
Ken: keep in mind that doctors don't necessarily have to perform procedures themselves to get financial benefits from having them performed. I'm not just talking about bald-assed kickbacks, although that kind of thing obviously goes on. Lots of doctors have financial stakes in a nearby hospital, or in a conveniently-situated diagnostic facility that you can see as soon as you step out of the doctor's office door (and it SURELY makes the most sense to just go over there right now and get it over with, doesn't it?).
That said, I've never actually seen a study on whether doctors who do own a stake in a lab order more tests than other doctors. If anyone knows of such a study, point a brother in the right direction.
Captain:
Here's a place to start:
http://www.ajronline.org/cgi/content/full/179/4/843
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