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• W144236502 abstract "The soaring cost of healthcare service demands alternative payment schemes to control expenditures while maintaining quality of service. The capitation payment scheme is a tentative substitute for the Fee-For-Service ( FFS ) scheme. A pilot capitation program study was conducted by the Bureau of National Health Insurance ( BNHI ) to evaluate the feasibility of a national rollout.  Estimating the potential outcomes of a specific pilot program, the multi-agent simulation approach is used to model and simulate the service system under different settings. In this study, we chose the Zhishan C ommunity H ealthcare G roup (CHG) service system as an example. The model was built and validated according to publicly available statistical and transactional data from Zhishan-CHG, and estimated the system’s financial sustainability under different conditions. Five scenarios were explored in the experiment, simulating the capitation payment scheme over a period of three years. The results are summarized as follows: (1) medical cost expenditure per person can be reduced as more patients are enrolled in the capitation program ; (2) the service model with a health promotion agent outperforms the model without one in an FFS cost control system; (3) higher quality and retention rate improve capitation income; (4) the financial risk of the CHG service system can be mitigated by excluding inpatient medical costs from the virtual points assigned by B NHI, and (5) simulation results show a positive financial outcome for Zhishan-CHG. These simulation results could be potentially used by the BNHI to revise its policy in terms of the population for one CHG and the coverage of medical services of a capitation payment system, such that the financial risk of the CHG could be reduced and the capitation policy sustained." @default.
• W144236502 created "2016-06-24" @default.
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• W144236502 date "2014-01-01" @default.
• W144236502 modified "2023-09-26" @default.
• W144236502 title "An Exploration of Capitation Payments for Healthcare Services Using a Multi-agent Simulation" @default.
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• W144236502 doi "https://doi.org/10.17705/1pais.06201" @default.
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