LETTER
Capitation and the Medicaid Elderly
Yizhak Twersky, MD, and
Harold Lipsky, MD
15 September 1994 | Volume 121 Issue 6 | Pages 469-470
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.
1. Lurie N, Christianson J, Finch M, Moscovice I. The effects of capitation on health and functional status of the Medicaid elderly. Ann Intern Med. 1994; 120:506-11.
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