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Accounting for morbidity in capitation payments: A person-based workload formula for primary medical care in England

Author

Listed:
  • Anselmi, Laura
  • Wang, Shaolin
  • Lau, Yiu-Shing
  • Anderson, Michael
  • Kontopantelis, Evangelos
  • Sutton, Matt

Abstract

Accurate needs-based capitation is key to effective and equitable primary care funding. Most capitation schemes use only basic demographic and area characteristics.

Suggested Citation

  • Anselmi, Laura & Wang, Shaolin & Lau, Yiu-Shing & Anderson, Michael & Kontopantelis, Evangelos & Sutton, Matt, 2025. "Accounting for morbidity in capitation payments: A person-based workload formula for primary medical care in England," Health Policy, Elsevier, vol. 161(C).
    • Handle: RePEc:eee:hepoli:v:161:y:2025:i:c:s0168851025001617
    DOI: 10.1016/j.healthpol.2025.105406
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    References listed on IDEAS

    as
    1. Hugh Gravelle & Matt Sutton & Ada Ma, 2010. "Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?," Economic Journal, Royal Economic Society, vol. 120(542), pages 129-156, February.
    2. Wang, Shaolin & Anselmi, Laura & Lau, Yiu-Shing & Sutton, Matt, 2025. "Predicting healthcare costs with diagnoses recorded in primary and secondary care: an analysis of linked records," Social Science & Medicine, Elsevier, vol. 378(C).
    3. John Mullahy & Edward C. Norton, 2024. "Why Transform Y? The Pitfalls of Transformed Regressions with a Mass at Zero," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 86(2), pages 417-447, April.
    4. Vallejo-Torres, Laura & Morris, Stephen & Carr-Hill, Roy & Dixon, Paul & Law, Malcom & Rice, Nigel & Sutton, Matthew, 2009. "Can regional resource shares be based only on prevalence data? An empirical investigation of the proportionality assumption," Social Science & Medicine, Elsevier, vol. 69(11), pages 1634-1642, December.
    5. Laura Anselmi & Yiu-Shing Lau & Matt Sutton & Anna Everton & Rob Shaw & Stephen Lorrimer, 2022. "Use of past care markers in risk-adjustment: accounting for systematic differences across providers," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(1), pages 133-151, February.
    6. Lo, Charlene & Anselmi, Laura & Sutton, Matt, 2025. "Horizontal equity in primary care financing: An assessment of payments to general practices in England, 2014–2022," Social Science & Medicine, Elsevier, vol. 373(C).
    7. Brilleman, Samuel L. & Gravelle, Hugh & Hollinghurst, Sandra & Purdy, Sarah & Salisbury, Chris & Windmeijer, Frank, 2014. "Keep it simple? Predicting primary health care costs with clinical morbidity measures," Journal of Health Economics, Elsevier, vol. 35(C), pages 109-122.
    8. Constantinou, Panayotis & Tuppin, Philippe & Gastaldi-Ménager, Christelle & Pelletier-Fleury, Nathalie, 2022. "Defining a risk-adjustment formula for the introduction of population-based payments for primary care in France," Health Policy, Elsevier, vol. 126(9), pages 915-924.
    9. Hugh Gravelle & Matthew Sutton & Stephen Morris & Frank Windmeijer & Alastair Leyland & Chris Dibben & Mike Muirhead, 2003. "Modelling supply and demand influences on the use of health care: implications for deriving a needs‐based capitation formula," Health Economics, John Wiley & Sons, Ltd., vol. 12(12), pages 985-1004, December.
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