Dataset Information

Evaluating health care programs by combining cost with quality of life measures: a case study comparing capitation and fee for service.

ABSTRACT:

Objective

To demonstrate cost-effectiveness analysis (CEA) for evaluating different reimbursement models.

Data sources/study setting

The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (n=522). Under capitation, services were provided either directly (direct capitation [DC]) by not-for-profit community mental health centers (CMHC), or in a joint venture between CMHCs and a for-profit managed behavioral health organization (MBHO).

Study design

A nonparametric matching method (genetic matching) was used to identify those cases that minimized baseline differences across the groups. Quality-adjusted life years (QALYs) were reported for each group. Incremental QALYs were valued at different thresholds for a QALY gained, and combined with cost estimates to plot cost-effectiveness acceptability curves.

Principal findings

QALYs were similar across reimbursement models. Compared with FFS, the MBHO model had incremental costs of -$1,991 and the probability that this model was cost-effective exceeded 0.90. The DC model had incremental costs of $4,694; the probability that this model was cost-effective compared with FFS was <0.10.

Conclusions

A capitation model with a for-profit element was more cost-effective for Medicaid patients with severe mental illness than not-for-profit capitation or FFS models.

SUBMITTER: Grieve R

PROVIDER: S-EPMC2517267 | biostudies-literature | 2008 Aug

REPOSITORIES: biostudies-literature

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Publications

Evaluating health care programs by combining cost with quality of life measures: a case study comparing capitation and fee for service.

Grieve Richard R Sekhon Jasjeet S JS Hu Teh-Wei TW Bloom Joan R JR

Health services research 20080317 4

<h4>Objective</h4>To demonstrate cost-effectiveness analysis (CEA) for evaluating different reimbursement models.<h4>Data sources/study setting</h4>The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (n=522). Under capitation, services were provided either directly (direct capitation [DC]) by not-for-profit community mental health centers (CMHC), or in a joint venture between CMHCs and a for-profit managed behavioral ...[more]

PMID: 18355261

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Dataset Information

Evaluating health care programs by combining cost with quality of life measures: a case study comparing capitation and fee for service.

Objective

Data sources/study setting

Study design

Principal findings

Conclusions

Publications

Evaluating health care programs by combining cost with quality of life measures: a case study comparing capitation and fee for service.

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