Setting Capitations for Medicaid: A Case Study
RAND CORP SANTA MONICA CA
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This article examines the methodology New York State used to set capitation rates for a Medical health maintenance organization. By examining the methods used and the assumptions made in a particular case, some general lessons are drawn about the ratesetting process. Greater reliance on statewide data to assure fair and statistically stable estimates is needed. Although the article focuses on one State and its ratesetting for one particular plan Health Care Plus, the issues raised have general interest for other plans for other States concerned with the setting of capitation rates for Medicaid enrollees in prepaid plans.
- Economics and Cost Analysis
- Medicine and Medical Research