Adult capped dental payment model applied within a university setting: an Australian reflective case study

Background Capitation models of care in dentistry started around 1973 with varying degrees of success in meeting the needs of the individuals and expectations of the participating private practitioners. These studies mostly identified that capitation payments resulted in under treatment whilst fee-for-service models often led to over treatment. The objective of this study was to develop a new way of doing business using an outsourcing capitation model of care to meet population health needs and activity-based funding requirements of rural Local Health Districts with a local university dental school. This payment model is an alternate referral pathway for public oral health practitioners from the existing New South Wales Oral Health Fee-for-Service Scheme that focuses on urgent treatment to one that offers an all-inclusive preventive approach that concentrates on sustaining good long-term oral health for the individual. Method The reflective study analysed various adult age cohorts (18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75 + years) based on 950 participants randomly selected from the Greater Southern adult public dental waiting lists. The study’s capitation formula was derived from NSW government adult treatment items (n = 447,625). Dental care was provided through the local university’s dental clinics utilising only dental students under clinical supervision. All data were sourced from NSW Oral Health Data Warehouse during 1 January 2012–30 June 2018 and analysed by using SAS 9.3 and Version 13 Microsoft Excel. Results There were 10,305 dental care items and 1129 capitation courses of care totalling A$599,026. This resulted in an average of 11 dental care items being provided to each participant. The capitation payment formula utilising the most provided dental care items of 100 individual patients proved to be economical and preventive focused. Conclusion The systematic reflection showed that this unique methodology in developing an adult capitation payment formula associated to diagnostic pathways that resulted in: (i) more efficient usage of government expenditure on public dental services, (ii) provision of person-centred courses of dental care, and (iii) utilisation of university dental education programs to best practice treatment and holistic care.

Twelve years with a capitation payment system in Swedish dental care: longitudinal development of oral health

Background Since 2007, patients receiving oral health care within the Public Dental Service in Sweden have had the possibility to choose between the traditional fee-for-service (FFS) payment system or the new capitation payment system, ‘Dental Care for Health’ (DCH). Payment models are believed to involve different incentive structures for patients and caregivers. In theory, different incentives may lead to differences in health-related outcomes, and the research has been inconclusive. This 12-year longitudinal prospective cohort study of patients in regular dental care analyzes oral health development and self-reported oral health in relation to the patients’ level of education in the two payment systems, and compares with the results from an earlier 6-year follow-up. Methods Information was obtained through a questionnaire and from a register from n = 5877 individuals who kept their original choice of payment model for 12 years, 1650 patients in DCH and 4227 in FFS, in the Public Dental Service in Region Västra Götaland, Sweden. The data comprised manifest caries prevalence, levels of self-reported oral health and education, and choice of dental care payment model. Analyses were performed with chi square and multivariable regression analysis. Results The findings from the 6-year follow-up were essentially maintained at the 12-year examination, showing that the pre-baseline caries prevalence is the most influential factor for less favorable oral health development in terms of the resulting caries prevalence. Educational level (≥ university) showed an increased influence on the risk of higher caries prevalence after 12 years and differed between payment models with regard to the relation to self-rated oral health. Conclusions Differences in health and health-influencing properties between payment models were sustained from 6 to 12 years. Strategies for making use of potential compensatory mechanisms within the capitation payment system to increase oral health equality should be considered.

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

In Poland, as in many other countries, the use of capitation payment schemes in primary health care is popular. Despite this popularity, the subject literature discusses its role in decreasing the quality of primary medical services. This problem is particularly important during COVID-19, when medical entities provide telehealth services to patients. The objective of the study is to examine the effects of COVID-19 pandemic on the performance of the primary health care providers in Poland under a capitation payment scheme. In this study the authors use data from interviews with personnel of medical entities and financial and administrative reports of primary health care providers in order to identify how this crisis situation impacts the performance of primary health care entities, under capitation payment system. The performance indicators include both the financial and quality measures. Selected to the case study primary health care service providers significantly improved their profitability due to considerable costs savings and reduction of services provided to patients in a time of COVID-19 pandemic. Capitation payment system proved to be inefficient, in the studied pandemic period, in terms of the services provided by primary health care service providers to patients and the funds paid to them, in exchange, by the government entities.

Policy Analysis of Used Capital Fund of National Health Insurance (JKN) To Increase Employee Performance on Primary Healthcare (FKTP)Puskesmas in Pacitan

Under the ministerial regulation no 21/2016 the payment of JKN service to the FKTP used capitation payment system. The payment given to the primary care is in the form of health service payment (minimum 60%). The allocation is based on types of workforce (profession, administrative tasks, person in charge of programs, and years of service) and attendance. This study investigates the possibility of adding employee performance as a variable in giving health service point for employees at FKTP Puskesmas. This study is a qualitative study in nature using case study design. The data were collected through in-depth interviews, focus group discussion, and triangulation. Incentive payment increases the employee performance at work. The amount of incentives should line up with the employees performances. Incentives will not be effective if they are fixed and do not count the employees performances. In the ministerial regulation no 21/2016, healthcare service is not included as a variable in employee performance evaluation. The head of FKTP Puskesmas can use the results of employee performance evaluation to determine the amount of incentives received. One of the ways to improve employee performance is through reward and punishment system. Employee performance in Puskesmas can be increased by adding work performance evaluation as a variable capitation payment of BPJS Kesehatan to Puskesmas based on ministerial regulation (Permenkes) no 21/ 2016.

Preferences of healthcare providers for capitation payment in Kenya: a discrete choice experiment

Provider payment mechanisms (PPMs) are important to the universal health coverage (UHC) agenda as they can influence healthcare provider behaviour and create incentives for health service delivery, quality and efficiency. Therefore, when designing PPMs, it is important to consider providers’ preferences for PPM characteristics. We set out to uncover senior health facility managers’ preferences for the attributes of a capitation payment mechanism in Kenya. We use a discrete choice experiment and focus on four capitation attributes, namely, payment schedule, timeliness of payments, capitation rate per individual per year and services to be paid by the capitation rate. Using a Bayesian efficient experimental design, choice data were collected from 233 senior health facility managers across 98 health facilities in seven Kenyan counties. Panel mixed multinomial logit and latent class models were used in the analysis. We found that capitation arrangements with frequent payment schedules, timelier disbursements, higher payment rates per individual per year and those that paid for a limited set of health services were preferred. The capitation rate per individual per year was the most important attribute. Respondents were willing to accept an increase in the capitation rate to compensate for bundling a broader set of health services under the capitation payment. In addition, we found preference heterogeneity across respondents and latent classes. In conclusion, these attributes can be used as potential targets for interventions aimed at configuring capitation to achieve UHC.

Capaian Indikator Kapitasi Berbasis Komitmen Pelayanan pada Puskesmas di Kota Semarang

Start from 2017, the capitation payment based on the fulfilment of service commitment has been implemented throughout all FKTP in Indonesia. There are three ration indicators of service commitment: contact number (≥150 per mile), ratio of participants of Prolanis who regularly visit (≥50%), and the ratio of non-specialistic outpatient referral (≤5%). The achievement of indicator target shows the service quality and influences the amount of capitation rate obtained by the Community Health Centre from BPJS Kesehatan. The research objective is to identify the glimpse of the achievement of the three indicators and the achievement of capitation number in 37 (thirty seven) Community Health Centres in Semarang City in 2018 and Semester 1 of 2019. The research method is descriptive observational, where during the the research, there has not been any intervention implemented. The data type used is quantitative data obtained from the secondary data of BPJS Kesehatan, Department of Health of Semarang City and Community Health Centres.The research result describes the average achievement of Contact Number of semester 1 and 2 in 2018 which reached 156.43 per mile and 157.08 per mile bigger that the indicator target, semester 1 of 2019 was 144.99 per mile, under the indicator target. Prolanis ratio describes that the Prolanis participants registered in Community Health Centres in Semarang City who regularly pay a visit to the Community Health Centres to obtain the service over chronic diseases they suffer continuously. Non-specialistic outpatient referral ratio suggests that the service quality in Community Health Centres in Semarang city is good. The average achievement of capitation payment based on the service commitment of the same period respectively is: 97,74%; 98,07%; 98,07%. Community Health Centre of Karanganyar has the lowest average achievement of capitation payment in 2018 as well as in Semester 1 of 2019 of 92.50% which shows that in average, there are 2 (two) indicators of capitation payment based on service commitment in Community Health Centres of Karanganyar which is located in unsafe zone during that period.Abstrak Mulai tahun 2017 pembayaran kapitasi berbasis pemenuhan komitmen pelayanan dilaksanakan di seluruh FKTP di Indonesia. Terdapat tiga rasio indikator komitmen pelayanan : angka kontak (≥150 per mil), rasio peserta prolanis rutin berkunjung (≥50%), dan rasio rujukan rawat jalan non spesialistik (≤5%). Pencapaian target indikator menunjukan kualitas pelayanan dan mempengaruhi besaran tarif kapitasi yang didapat Puskesmas dari BPJS Kesehatan. Tujuan penelitian untuk mengetahui gambaran pencapaian ketiga indikator dan capaian besaran kapitasi pada 37 (tigapuluh tujuh) Puskesmas di Kota Semarang tahun 2018 dan semester 1 tahun 2019. Jenis penelitian adalah observasional deskriptif, dimana selama penelitian berlangsung tidak dilakukan intervensi. Jenis data yang digunakan : data kuantitatif, yang berasal dari data sekunder BPJS Kesehatan, Dinas Kesehatan Kota Semarang. Hasil penelitian menggambarkan rata-rata capaian Angka Kontak semester 1 dan semester 2 tahun 2018 mencapai 156,43 per mil dan 157,08 per mil lebih besar dari target indikator, semester 1 tahun 2019 adalah 144,99 per mil, di bawah target indikator. Rata-rata capaian peserta Prolanis rutin berkunjung dan rata-rata capaian rasio rujukan rawat jalan non spesialistik pada periode yang sama, hasilnya di atas target indikator. Rata-rata capaian pembayaran kapitasi pada periode yang sama berturut-turut : 97,74%; 98,07%; 98,07%. Puskesmas Karanganyar rata-rata capaian pembayaran kapitasinya terendah selama tahun 2018 serta semester 1 tahun 2019 sebesar 92,50%.

Attribute development and level selection for a discrete choice experiment to elicit the preferences of health care providers for capitation payment mechanism in Kenya

Background Stated preference elicitation methods such as discrete choice experiments (DCEs) are now widely used in the health domain. However, the “quality” of health-related DCEs has come under criticism due to the lack of rigour in conducting and reporting some aspects of the design process such as attribute and level development. Superficially selecting attributes and levels and vaguely reporting the process might result in misspecification of attributes which may, in turn, bias the study and misinform policy. To address these concerns, we meticulously conducted and report our systematic attribute development and level selection process for a DCE to elicit the preferences of health care providers for the attributes of a capitation payment mechanism in Kenya. Methodology We used a four-stage process proposed by Helter and Boehler to conduct and report the attribute development and level selection process. The process entailed raw data collection, data reduction, removing inappropriate attributes, and wording of attributes. Raw data was collected through a literature review and a qualitative study. Data was reduced to a long list of attributes which were then screened for appropriateness by a panel of experts. The resulting attributes and levels were worded and pretested in a pilot study. Revisions were made and a final list of attributes and levels decided. Results The literature review unearthed seven attributes of provider payment mechanisms while the qualitative study uncovered 10 capitation attributes. Then, inappropriate attributes were removed using criteria such as salience, correlation, plausibility, and capability of being traded. The resulting five attributes were worded appropriately and pretested in a pilot study with 31 respondents. The pilot study results were used to make revisions. Finally, four attributes were established for the DCE, namely, payment schedule, timeliness of payments, capitation rate per individual per year, and services to be paid by the capitation rate. Conclusion By rigorously conducting and reporting the process of attribute development and level selection of our DCE,we improved transparency and helped researchers judge the quality.