+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Including health status in Medicare's Adjusted Average Per Capita Cost capitation formula



Including health status in Medicare's Adjusted Average Per Capita Cost capitation formula



Medical Care 24(3): 259-275



Actuarial factors currently comprising Medicare's HMO capitation formula, the Adjusted Average Per Capita Cost (AAPCC), are considered by many researchers to be inadequate as predictors of future period health care costs. While it is often suggested that the formula should incorporate beneficiary health status, no measure of health status suitable for this purpose has yet been identified. The authors present initial results from a study of 1,934 randomly selected Medicare beneficiaries in Michigan. Beneficiaries were surveyed to obtain data on several alternative measures of health status. Medicare claims were used to estimate beneficiary health care costs for periods before and after the survey. In regressions on future period Medicare payments, equations including the AAPCC factors plus a health status measure achieved R2 values ranging from 0.013 to 0.072, depending on the health status measure, compared with an R2 value of 0.003 for the equation with AAPCC factors alone.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 040403978

Download citation: RISBibTeXText

PMID: 3512927

DOI: 10.2307/3764651


Related references

Improving the AAPCC (adjusted average per capita cost) with health-status measures from the MCBS (Medicare Current Beneficiary Survey). Health Care Financing Review 17(3): 59-75, 1997

Including a measure of health status in Medicare's health maintenance organization capitation formula: reliability issues. Medical Care 25(2): 100-110, 1987

Including a Measure of Health Status in Medicare's Health Maintenance Organization Capitation Formula: Reliability Issues. Medical Care 25(2): 100-110, 1987

An analysis of selectivity bias in the Medicare AAPCC (adjusted average per capita cost). Health Care Financing Review 17(3): 35-57, 1997

Adjusting the AAPCC (adjusted average per capita cost) for selectivity and selection bias under Medicare risk contracts. Advances in Health Economics and Health Services Research 10: 111-149, 1988

Using health indicators in calculating the AAPCC (adjusted average per capita cost). Advances in Health Economics and Health Services Research 10: 75-109, 1988

Increasing Medicare enrollment in HMOs: the need for capitation rates adjusted for health status. Inquiry 20(3): 227-239, 1983

Reform of the Medicare AAPCC: learning from previous proposals. Average Adjusted Per Capita Costs. Inquiry 35(1): 62-77, 1998

Analysis of underwriting factors for AAPCC (adjusted average per capita cost). Health Care Financing Review 14(1): 117-132, 1993

Health status adjustments for Medicare capitation. Inquiry 24(4): 362-375, 1987

Risk-adjusted capitation in an era of personalized medicine: a dangerous opportunity to bend the health care cost curve. Medical Care 50(8): 633-634, 2012

Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information. Health Services Research 33(6): 1727-1744, 1999

Medicare's risk-adjusted capitation method. Journal of Health Care Finance 28(3): 105-119, 2002

Medicare risk-adjusted capitation payments: from research to implementation. Health Care Financing Review 21(3): 1-5, 2000

Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financing Review 17(3): 77-99, 1996