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Capitation and the Medicaid Elderly
- Yizhak Twersky, MD; and
- Harold Lipsky, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Based on their study in which patients with prepaid care and patients with fee-for-service care received similar medical care, Lurie and colleagues [1] concluded that enrolling elderly Medicaid patients in prepaid health plans is not harmful. This conclusion is flawed. The primary coverage for most patients in this study was Medicare; Medicaid was only used for the copayment and deductible portion of the Medicare program and the services not covered by Medicare such as dental care, occupational therapy, and so forth. To capitate the copayment (which is already severely limited by statute) would not alter access to health care, and to imply that prepaid care is as good as fee-for-service based on this maneuver is misleading.
Furthermore, in this study, capitation does not show real savings. Although the average annual Medicaid per-person expenditure was $715 lower for the prepaid group than that for the fee-for-service group, the Medicare cost for these same patients with prepaid care was $462 higher. When this increased cost is considered, it is doubtful that there are any significant savings; this is merely robbing Peter to pay Paul.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
