IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

Using selected diagnoses to improve the Chilean capitation formula

Listed author(s):
  • Vargas, Veronica
  • Wasem, Jürgen

Objectives: To contribute to the policy discussion of equity and health financing in Chile by evaluating the improvement in the capitation formula for paying PHC providers by using selected diagnoses. The socio-economic status of the municipalities and the urban/rural location of providers are used to adjust current capitation payments to providers. Issues have been raised about the ability of the formula to predict the utilization of PHC. In this study we test if adding individual information, such as age, gender and selected diagnoses improves the formula's explanatory power. Age, gender and diagnosis are important variables because of their strong relationship to increased morbidity risk and to needs for preventive and reproductive health care respectively. Methods: A sample of 10,000 individuals was drawn and two years utilization-of- services data was collected from a region in Chile. Information on age, gender, socio-economic status and urban/rural residence, the number of preventive or curative visits and the presence of seven key diagnoses was collected. Regression analysis and two tests to identify the best model were performed: i) R-square, which measures the proportion of the variance in individual expenditures and ii) predictive-ratio which measures the accuracy of prediction at the group level (where 1.0 indicates perfect prediction). Conclusions: We recommend to add age, gender and two diagnoses; hypertension and diabetes to the current capitation formula. The explanatory power of this model at the individual level was 28.5% and at health centre level the predictive ratio was close to 1.0.

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

File URL:
Download Restriction: no

Paper provided by Ernst Moritz Arndt University of Greifswald, Faculty of Law and Economics in its series Wirtschaftswissenschaftliche Diskussionspapiere with number 06/2002.

in new window

Date of creation: 2002
Handle: RePEc:zbw:grewdp:062002
Contact details of provider: Postal:
Friedrich-Loeffler-Str. 70 - 17489 Greifswald

Phone: (03834) - 86-2452
Fax: (03834) 86-2451
Web page:

More information through EDIRC

References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

in new window

  1. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
  2. Brian Hutchison & Jeremiah Hurley & Stephen Birch & Jonathan Lomas & Stephen Walter & John Eyles & Fawne Stratford-Devai, 2000. "Needs-based primary medical care capitation: Development and evaluation of alternative approaches," Health Care Management Science, Springer, vol. 3(2), pages 89-99, February.
  3. Arlene Ash & Randall P. Ellis & Gregory Pope & John Ayanian & David Bates & Helen Burstin & Lisa Iezzoni & Elizabeth McKay & Wei Yu, 2000. "Using Diagnoses to Describe Populations and Predict Costs," Papers 0099, Boston University - Industry Studies Programme.
Full references (including those not matched with items on IDEAS)

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

When requesting a correction, please mention this item's handle: RePEc:zbw:grewdp:062002. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (ZBW - German National Library of Economics)

If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

If references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

Please note that corrections may take a couple of weeks to filter through the various RePEc services.

This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.