Social and Healthcare Reform and Assessment of Risk for Capitation Reimbursements for New Social and Healthcare Centres
Abstract
Background
The social and healthcare reform in Finland aims to create social and healthcare centres that patients can choose between. Both private and public organizations can establish these centres. The reimbursement scheme for the centres is based on the number of listed patients and capitation payments.
Methods
Data used in the study comprises patient level information on all social and healthcare services used by the citizens of the city of Oulu in 2013: services and benefits provided by the city and the local hospital district, services and benefits paid by the Social Insurance Institution of Finland and occupational healthcare services provided by employers. The cost of services to be provided by the new social and healthcare centre was the dependent variable. The independent variables comprised data on chronic diseases, use of social services, age, income, and eligibility for occupational healthcare. Statistical methods used are Pearson’s correlation and linear OLS regression.
Results
The average cost for social and healthcare centre services was 127 € and about 55% of the population did not use services during 2013 at all. Those eligible for occupational healthcare services had an average cost of 62 €. The variables with the highest correlation with the cost of social and healthcare centre services in 2013 were the cost for 2012, the number of long term diseases, age, and eligibility for occupational healthcare.
Conclusions
Several factors are correlated with the use of primary care services. If these factors are not taken into consideration in the capitation reimbursements paid to providers for each listed citizen, the reimbursement is not reflective of the individual need for services and can lead to customer selection. There are also customer groups that have alternative channels for primary care services: university students and those employees who have healthcare through their employer. Thus, the availability of substitute services for a part of the population should be taken into account when determining the level of capitation reimbursements. However, there is still a lot of unexplained variation in the use of primary care services: the need for services is somewhat random. This means that even after adjustments in the reimbursement levels, the service providers are left with considerable
risk, especially if the customer base is small.
Authors
Riikka-Leena Leskelä, Hanna Hovi, Paula Pennanen, Mikko Nuutinen, Sirkku Pikkujämsä, Hennamari Mikkola
Additional Information
- Peer-Reviewed: yes.
- Open Access: yes.
- Cite as: Leskelä, R.-L., Hovi, H., Pennanen, P., Nuutinen, M., Pikkujämsä, S., & Mikkola, H. (2018). Sote-keskuksen kapitaatiokorvauksen määrittely: mitä taustatekijöitä tulisi ottaa huomioon? Suomen lääkärilehti, 73(23), 1494-1498. https://www.laakarilehti.fi/pdf/2018/SLL232018-1494.pdf
