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Capitation and indemnity in dental insurance.

M Tekavec, C Tekavec

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Abstract

The literature reviewed over the past year indicates several new trends in the area of health care capitation and indemnity third-party coverage. These trends point toward an increase in capitation and managed care and a decrease in traditional indemnity insurance. As employers seek to control all types of health care costs, they will also require employees to take care of a larger portion of the bill. As managed care plans increase, there will be a new emphasis on methods of plan evaluation. Cost will cease to be the only consideration. As quality comes into greater focus, there will be a need to define quality care in objective terms. Parameters of care will be needed as well as performance standards. Providers will be put increasingly at financial risk as managed care administrators seek to reduce provider numbers and control utilization. Capitated dental care is not as prevalent nationwide as is capitated medical care. Developments in general health care will influence how widespread it will become in the next decade.

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What this paper is about

The literature reviewed over the past year indicates several new trends in the area of health care capitation and indemnity third-party coverage. These trends point toward an increase in capitation and managed care and a decrease in traditional indemnity insurance. As employers seek to control all types of health care costs, they will also require employees to take care of a larger portion of the bill. As managed care plans increase, there will be a new emphasis on methods of plan evaluation. Cost will cease to be the only consideration. As quality comes into greater focus, there will be a need to define quality care in objective terms. Parameters of care will be needed as well as performance standards. Providers will be put increasingly at financial risk as managed care administrators seek to reduce provider numbers and control utilization. Capitated dental care is not as prevalent nationwide as is capitated medical care. Developments in general health care will influence how widespread it will become in the next decade.

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Available abstract

The literature reviewed over the past year indicates several new trends in the area of health care capitation and indemnity third-party coverage. These trends point toward an increase in capitation and managed care and a decrease in traditional indemnity insurance. As employers seek to control all types of health care costs, they will also require employees to take care of a larger portion of the bill. As managed care plans increase, there will be a new emphasis on methods of plan evaluation. Cost will cease to be the only consideration. As quality comes into greater focus, there will be a need to define quality care in objective terms. Parameters of care will be needed as well as performance standards. Providers will be put increasingly at financial risk as managed care administrators seek to reduce provider numbers and control utilization. Capitated dental care is not as prevalent nationwide as is capitated medical care. Developments in general health care will influence how widespread it will become in the next decade.

Key concepts: Indemnity, Capitation, Managed care, Business, Health care, Capitation fee, Control (management), Actuarial science

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