Trends in Provider Capitation, 1996-2000 Samuel Zuvekas and Joel W. Cohen

Agency for Healthcare Research and Quality Working Paper No. 04006 November 2004

Suggested citation: Zuvekas S, Cohen JW. Trends in Provider Capitation, 1996-2000. Agency for

Healthcare Research and Quality Working Paper No. 04006, November 2004,

http://www.ahrq.gov.

AHRQ Working Papers provide preliminary analysis of substantive, technical, and methodological

issues. The papers are works in progress and have not undergone a formal peer review. They

are distributed to share valuable experience and research. Comments are welcome and should

be directed to the authors. The views expressed are those of the authors and no official

endorsement by the Agency for Healthcare Research and Quality or the Department of Health

and Human Services is intended or should be inferred.
Trends in Provider Capitation, 1996-2000 

Samuel H. Zuvekas and Joel W. Cohen 

November 2004 

ABSTRACT 

Objective: We examine the extent to which the health care services delivered by physicians and 

hospitals in public and private health plans are capitated, and how this changed from 1996 to 

2000. 

Study Design: The data are drawn from the 1996 to 2000 years of the nationally representative 

Medical Expenditure Panel Survey (MEPS). Information on whether health care use was 

covered by capitated arrangements was obtained from billing offices of physicians and hospitals, 

in a follow-back survey of providers used by MEPS household members. 

Methods: We compare changes from 1996 to 2000 in the percentage of office-based physician 

visits, hospital outpatient department (OPD) visits, hospital emergency department (ED) visits, 

and hospital inpatient stays that are covered by capitation arrangements. We also compare 

differences by health insurance coverage, including HMO coverage, and selected sociodemographic characteristics. We use standard two-tail tests of significance, which are calculated 

taking into account the complex survey design of the MEPS. 

Results: We find that only 15 percent of visits to office-based physicians were capitated in 1996, 

declining to 13 percent in 2000. Even among HMO enrollees, visits covered by a provider 

capitation arrangement represented a minority of all office visits, declining to 25 percent for 

Private HMO enrollees and 15 percent for Medicaid HMO enrollees in 2000. Even smaller 

proportions of hospital services were capitated. 

Conclusions: Capitation remains relatively rare even among public and private HMO enrollees. 

Samuel H. Zuvekas 

Senior Economist 

Division of Social and Economic Research 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 

Email: szuvekas@ahrq.gov 

Joel W. Cohen 

Director, Division of Social and Economic Research 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 

Email: jcohen@ahrq.gov 

2
 
 

 

Introduction 

After extraordinary growth through the late 1990s, managed care has clearly lost some 

momentum. The number of individuals enrolled in Health Maintenance Organizations (HMOs) 

doubled from 39 million in 1992 to a peak of 80.5 million in 1999, but has since declined to 74 

million by 2002.1,2 Enrollment in Preferred Provider Organizations (PPOs) grew rapidly between 

1990 and 1996 from 38 million to 98 million individuals, but slowed substantially afterwards 

with approximately 105 million individuals enrolled in 2001.3,4 

The growth in managed care brought with it a substantial movement away from 

traditional charged-based payment arrangements and toward payment based on cost-containing 

approaches such as capitation, fee schedules, and negotiated rates. Capitation, in particular, once 

held great promise as a means to contain costs and is often thought of as synonymous with 

HMOs. However, there is often a great deal of confusion about the distinction between capitation 

payments to health plans for coverage under a plan, for example, as in Medicare and Medicaid 

HMOs, and capitation payments to providers for the provision of care, for example, under a risk 

contract between a health plan and a specific provider. Although capitation is often used to 

describe both situations, they are fundamentally different. At the plan level, capitation can be 

thought of as a premium paid for health insurance coverage, but does not necessarily imply a 

specific method of paying individual providers. At the provider level, capitation is a substitute 

for fee-for-service payment in which a flat amount, for example, some amount per person per 

month, is paid to cover all of the services provided. From a theoretical perspective, the promise 

of capitation in both cases comes from the shifting of risks to the health plan or provider, thus 

creating strong incentives to restrain health care utilization and costs.5,6 

3
 
By the late 1990s, the proportion of physicians in practices with any type of managed 

care contract had reached a peak of 92 percent, and more than one-third of physicians were in 

practices that had contracts that involved capitation.7 However, along with a leveling off of the 

number of physicians in practices with any type of managed care contract, the average amount of 

practice revenue derived from these contracts has also leveled off in recent years at about 40 

percent according to AMA physician surveys.8 Never large, the average amount of physician 

practice revenue derived from capitated contracts appears to have declined slightly to 

approximately 7 percent by 2001, according to another physician survey.8,9 These physician 

surveys suggest that capitation of providers is far less common than capitation of health plans. 

In contrast, a recent Medicare Payment Advisory Commission (MEDPAC) funded study of 

financing arrangements within HMOs in selected markets concluded that “While capitation 

arrangements are particularly common in California, they are more common elsewhere than 

many assume.”10 

We examine the extent to which health care services were actually covered by capitation 

arrangements and how this changed between 1996 and 2000 using data from the nationally 

representative Medical Expenditure Panel Survey (MEPS). While previous surveys of 

physicians have estimated the percent in practices with capitated contracts and the average 

percentage of practice revenue derived from these contracts, there is little information available 

nationally on the extent to which individual medical events are provided under capitated 

reimbursement arrangements. That is, from the consumer’s perspective, how much of their 

health care use is actually capitated? Unlike most previous studies, we are able to examine how 

capitation varies among Medicare, Medicaid, and private health insurance enrollees, and, 

specifically, how much of the health care received by enrollees in HMO plans is capitated. In 

4
 
 

addition to physicians visits, we are also able to examine trends in capitation of hospitalprovided services. Finally, we are able to examine how the prevalence of capitation varies among 

individuals by sociodemographic characteristics. 

DATA AND METHODS 

Data Source 

Our data come from years 1996 through 2000 of the MEPS, which is a large ongoing 

nationally representative survey of the U.S. civilian non-institutionalized population sponsored 

by the Agency for Healthcare Research and Quality (AHRQ). We combined data on health care 

use and personal characteristics from the MEPS Household Component (MEPS-HC) with billing 

and reimbursement data (including capitation) from the Medical Provider Component (MEPSMPC), a follow-back survey of health care providers identified by MEPS respondents. The 

MEPS-MPC collects billing data for a sample of all the office-based doctors reported by MEPS 

respondents in all years, with heavy over-sampling of providers of households with Medicaid or 

HMO coverage. Billing data were collected for all reported hospitals in 1996, 1999, and 2000 

and a sample of hospitals in 1997 and 1998.11 

Because the MEPS-MPC was not designed as a standalone survey, sampling weights 

were never developed by AHRQ to account for the fact that not all providers were contacted to 

obtain billing information, either because the provider was not sampled or a signed permission 

form was not obtained from the MEPS respondent. Once contacted the great majority of office 

based physician’s offices (86 percent in 1996) and hospitals (93 percent in 1996) participated in 

the MEPS-MPC, and virtually all the providers participating provided information on whether 

5
 
 

they were capitated or not for the services that were provided to the MEPS household members. 

For a variety of technical reasons, we did not attempt to construct our own weights to use the 

MEPS-MPC capitation data. Instead, we used regression-based methods to predict capitation for 

all health care events reported by MEPS households, so that estimates of capitation could be 

made for the full, nationally representative MEPS-HC sample with the regular MEPS sampling 

weights. Our methods are similar to those used in the development of the MEPS expenditure 

estimates (with the exception that we use regression-based rather than weighted sequential hotdeck methods) as described in the MEPS Public Use File Documentation.12 Our estimates of 

capitation prevalence rates are not sensitive to whether the predicted capitation rates for the full 

MEPS sample or actual capitation rates for the subset of the MEPS sample for which capitation 

data are available. This, along with additional analyses not reported here, suggests that nonresponse bias (at least along observable characteristics) is negligible. 

Measuring Capitation 

We measure the percentage of office-based doctor visits, hospital outpatient department 

visits, emergency department room visits, and hospital stays, respectively, that were covered by a 

capitation arrangements. This measure is based on responses to the following question asked in 

the MEPS-MPC: “Was the facility/practice reimbursed for (this visit/these visits/stay) on a feefor-service basis or a capitated basis?.” If necessary, interviewers provided the following 

definitions: “Fee-for-service means that the practice was reimbursed on the basis of the services 

provided. Capitated basis means that the patient was enrolled in a prepaid managed care plan 

where reimbursement is not tied to specific visits.” The wording for this and the other MEPSMPC questions were developed through extensive focus group and field-testing. 

6
 
We note that for office-based sole-practioners and hospitals, our capitation variable 

simply measures whether the provider for each visit or stay was reimbursed on a fee-for-service 

basis by the health plan, or whether the visit or stay was covered by some capitated arrangement. 

For physician group practices, the capitation variable measures how the group was reimbursed 

by the health plan for each visit, but not how individual providers were paid within the group. 

For example, visits to providers in group and staff model HMOs would generally be considered 

to be capitated, because the physician groups are usually paid on a capitated basis even if 

individual providers are salaried. Visits to providers in other types of HMOs or Point of Service 

plans may or may not be covered by capitation arrangements. Similarly, hospital-based services 

delivered in hospitals owned by HMOs are considered capitated in the MEPS-MPC. Health care 

services provided by hospitals not-owned by HMOs are considered capitated only if they are 

provided under a capitation contract between an HMO and the hospital. 

Analyses 

We compare changes from 1996 to 2000 in the percentage of office-based physician 

visits, hospital outpatient department (OPD) visits, hospital emergency department (ED) visits, 

and hospital inpatient stays that are capitated. We include estimates of changes in capitation by 

Medicaid, Medicare, and private health plans, and specifically within Medicaid and Private 

HMOs. MEPS data on Medicare HMO enrollment was not considered reliable and was therefore 

no longer released after 1996. We also examine differences in capitation by sociodemographic 

characteristics including age, race and ethnicity, sex, health status, family income, census region, 

and urbanicity. We use standard two-tail tests of significance, which are calculated taking into 

7
 
account the complex survey design of the MEPS. All results reported in the text are statistically 

significant at the .05 level unless otherwise noted. 

RESULTS 

Office-Based Physician Visits 

We present descriptive statistics of the percent of visits to office-based physicians by the 

U.S. community population in Exhibit 1. Capitation of office-based physician visits remained 

relatively uncommon in the period 1996 through 2000. Only 15.5 percent of all visits to 

physicians were capitated in 1996 and subsequent years, dipping slightly to 13.0 percent in 2000. 

The considerable slowdown in overall HMO enrollment during the late 1990s explains in part 

why capitation did not become more common. More surprising is the level of capitation within 

HMOs themselves. Capitation arrangements covered only a minority of physician visits by 

persons who reported HMO coverage. Only one in three visits to physicians by persons enrolled 

in HMOs with private health insurance coverage were capitated in 1996 declining to one in four 

visits in 2000. Among those enrolled in Medicaid HMOs, only about one in four physicians 

visits were capitated in 1996 declining still further in 2000 (14 percent). 

Capitation of physician visits was far more common in the West compared to other 

regions, with about 1 in 4 visits covered by capitated arrangements on average during the 1996-

2000 period. This reflects the much greater HMO enrollment in the West, especially in Staff and 

Group model HMOs. Among HMO enrollees, capitation of visits was also almost twice as 

common in the West compared with other regions (data not reported). Similarly, physician visits 

were three times as likely to be capitated for those residing in Metropolitan Statistical Areas 

8
 
(MSA) compared to those who did not. Only 5 percent of physician visits by those living in nonMSAs were capitated, reflecting much lower managed care penetration in rural areas. 

Variations in the percent of physician visits that were capitated by other socioeconomic 

characteristics tended to be smaller. A somewhat greater percentage of physician visits by 

children under the age of 18 were capitated in all years. In 2000, 16 percent of visits by those 

under the age of 18 were capitated compared to 13 percent for adults 18-64 and 11 percent for 

those 65 and over. This may be due to the greater likelihood of well-child and other visits to 

pediatricians and other primary care physicians, who are more likely to be capitated, rather than 

specialists. Physician visits by Hispanics were more likely to be capitated than those by other 

groups in 2000, reflecting their greater HMO enrollment. Initial differences between Blacks and 

whites/others in 1996 were narrower and not statistically significant in 2000. 

Physician visits by persons with family incomes below or near the poverty line were 

somewhat less likely to be capitated, in spite of heavy managed care penetration in the Medicaid 

program. Differences by health status, though statistically significant, were small. About 14 

percent of office-based physician visits by those reporting poor or fair health were capitated in 

2000 compared to 12 percent by those reporting good to excellent health. These differences by 

income and health status reflect a combination of differences in HMO enrollment patterns, 

propensity to use any services, and intensity of health care use. 

Hospital-Based Services 

Capitation for hospital-based services was even less common in the years 1996 through 

2000. We see in Exhibit 2 that in 2000, only 4.5 percent of outpatient department (OPD) visits 

were covered by capitated arrangements. Capitation for OPD visits was uncommon even in 

9
 
 

 

HMOs; 10 percent of visits by persons enrolled in private HMOs and 2 percent of visits by 

persons in Medicaid HMOs in 2000. In a pattern consistent with office-based visits, OPD visits 

by children, Hispanics, those in poor or fair health, and those with family incomes above 125 

percent of the poverty line were all associated with a greater likelihood of being capitated. 

Geography was an even stronger determinant of capitation for OPD visits compared to officebased visits. By 2000, 18 percent of OPD visits by persons living in the West were capitated, 

compared to less than 3 percent for the rest of the country. The existence of HMO-owned 

hospitals by staff/group model HMOs in the West, combined with a low prevalence of capitation 

among HMOs that do not own their own hospitals, likely explains much of this difference. In 

addition, it is more common for outpatient visits of persons residing in MSAs to be capitated 

than those visits for those who do not live in MSAs. 

The prevalence of capitation for emergency department visits (ED) remained relatively 

flat from 1996 to 2000 at about 3 to 5 percent, as shown in Exhibit 3. As with OPD visits, 

capitation of ED visits was uncommon even among HMO enrollees, with only 11 percent of 

visits by private HMO enrollees covered by capitation arrangements and 6 percent of visits by 

Medicaid enrollees. The distribution of capitated ED visits by socioeconomic characteristics is 

remarkably similar to that of OPD visits. The exceptions being that the differences by perceived 

health status and age for OPD visits were not statistically significant for ED visits. Once again, 

geography plays the predominant role in explaining patterns of capitation of hospital ED visits. 

As shown in Exhibit 4, the prevalence of capitation for hospital inpatient stays (4 percent 

in 2000) was about the same as for hospital OPD and ED visits. From a theoretical standpoint, 

inpatient stays are the most difficult hospital service to capitate, because they occur much less 

frequently than OPD and ER visits and are subject to much higher variability in costs. The most 

10
 
 

likely explanation for why the prevalence of capitation for inpatient stays is about the same as 

other hospital services is that capitation of hospital services exists primarily in HMO-owned 

hospitals, where all services are considered capitated as defined in the MEPS. 

DISCUSSION 

Our results provide additional evidence that capitation of providers, as opposed to 

capitation of health plans, is relatively uncommon in the U.S. health care system. Although 

some 79 million Americans were enrolled in public and private HMO plans in 2000, the majority 

of their health care use was covered by fee for service arrangements and not capitation. In fact, 

the percentage of office-based physician visits covered by capitation arrangements actually 

declined among those with HMO coverage between 1996 and 2000, as it did for most hospitalbased services. Provider capitation within HMOs outside the West was even rarer. It appears 

that, in spite of the theoretical promise as a cost-containment mechanism, provider capitation 

never really expanded much beyond staff and group model HMOs. Even with staff and Group 

model HMOs, individual physicians tend to be salaried, blunting the incentive effects of 

capitation to the physician group. 

11
 
Why is provider capitation rare and becoming rarer? 

We offer several possible explanations for the low prevalence of provider capitation even 

within HMO plans. By definition, capitation contracts place risk on providers, but providers 

likely vary in their willingness to accept risks. Sole or small group practices may be less willing 

to accept risks than large practices, because they have fewer patients to spread the risks over. 

Health care expenses are highly concentrated in the United States, with the top 1 percent of 

health care users accounting for 27 percent of all health care expenses.13 A few very sick patients 

can have a large impact on a small physician practice. The potential for adverse selection of 

these very sick patients also increases the risks for larger practices. We note that hospital-based 

services are even less likely than office-based physicians to be reimbursed on a capitated basis 

because they are lower probability but higher cost events. Furthermore, if providers are risk 

adverse then they may demand a risk premium to accept capitated contracts, reducing potential 

cost savings to the plan over fee-for-service arrangements. 

Capitated contracts are also administratively more complex than fee for service 

arrangements likely leading to higher transaction costs for providers and plans alike. This is 

especially true outside of staff/group model HMOs where the sole practitioner or group may 

have contracts with many different HMOs and a corresponding mix of patients. These 

transaction costs may reduce or eliminate any potential cost savings, making capitation less 

attractive to the plan and further decreasing providers’ willingness to accept capitation instead of 

fee for service contracts. Transaction costs certainly at least partially explain why despite strong 

theoretical arguments that mixed capitation/fee for service reimbursement arrangements are 

optimal, they are almost never implemented in practice. 

12
 
The much talked about push-back against managed care reflected in the slow-down in 

enrollment, and indeed reduction in HMO enrollment, may signal a shift in bargaining power 

between physician practices and health plans. If so, physicians may be even less willing to 

accept capitated contracts that impose greater risks and higher transaction costs. 

Finally, the empirical literature on the effectiveness of provider capitation in reducing or 

restraining health care cost growth is mixed and surprisingly sparse.14-16 If capitation cannot 

clearly demonstrate these cost savings in practice, it is little wonder that it has not caught on 

more widely. 

Caveats 

We note at least two limitations in our trend analyses. First, our analyses are limited to 

actual health care events and whether they are covered by capitated and non-capitated 

arrangements. As a result, we may underestimate the extent of capitation arrangements because 

we cannot observe these arrangements among HMO enrollees that do not use any health care 

services. This measure similarly does not reflect the extent to which capitation reduces the 

intensity of health care use among HMO enrollees those that do use services. However, to the 

extent that this bias is relatively constant over the period 1996-2000, the trend analyses are 

unaffected. 

Second, our measure of capitation describes how groups are reimbursed by health plans, 

but not how individual providers are paid within the group (for example, strictly fee for service, 

salary, and revenue sharing arrangements). Thus, capitation of health care services at the level of 

the individual provider actually delivering the services is even rarer. 

13
 
 

Future Directions 

While plan level capitation in the form of HMOs has not grown over the last few years, it 

is still a significant force in the U.S. health care system. In contrast, capitation of providers 

remains rare, in spite of the theoretical arguments that have been advanced for either pure or 

mixed provider capitation reimbursement. As debate over cost-containment mechanisms begins 

anew with the recent acceleration in health care costs, it is all the more imperative to understand 

why this once promising cost-containment mechanism has failed to catch on. 

14
 
CITED REFERENCES 

1.	 Interstudy. The Interstudy Competetive Edge 13.1, Part II: HMO Industry Report. St. Paul, 

MN: Interstudy Publications; 2003. 

2.	 Interstudy. The Interstudy Competetive Edge 12.1, Part II HMO: Industry Report. St. Paul, 

MN: Interstudy Publications; 2003. 

3.	 American Association of Health Plans. 1999 Industry Profile: A Health Plan Reference 

Book. Washington, DC: AAHP; 1999. 

4.	 Interstudy. The Interstudy PPO Directory & Performance Report 2.0. St. Paul, MN: 

Interstudy Publications; 2001. 

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6.	 

7.	 

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Robinson JC. Theory and practice in the design of physician payment incentives. The 

Milbank Quarterly. 2001;79(2): 149-77. 

Selden TM. A model of capitation. The Journal of Health Economics. 1990; 9(4): 397-409. 

American Medical Association. Physician Socioeconomic Statistics, 1998. Chicago, IL: 

AMA Press,; 1998. 

American Medical Association. Physician Socioeconomic Statistics, 2003. Chicago, IL: 

AMA Press; 2003. 

Strunk BC, Reschovsky JD. Kindler and Gentler: Physicians and Managed Care, 1997-

2001. Tracking Report No. 5. Washington, D.C.: Center for Studying Health Systems 

Change; 2002. 

Gold MR, Lake T, Hurley R, Sinclair M. Financial risk sharing with providers in health 

maintenance organizations, 1999. Inquiry. 2002; 39(Spring): 34-44. 

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11. Machlin S and Taylor AK. Design, Methods, and Field Results of the 1996 Medical 

Expenditure Panel Survey Medical Provider Component, MEPS Methodology Report No. 9, 

AHRQ Pub. No. 00-0028. Rockville, MD: Agency for Healthcare Research and Quality; 

2000. 

12. Agency for Healthcare Research and Quality. MEPS HC-051G: 2000 Office-Based 

Medical Provider Visits, Public Use File Documentation. Rockville, MD: Agency for 

Healthcare Research and Quality; 2003. 

13. Berk M, Monheit AC. The concentration of health expenditures revisited. Health Affairs. 

2001; March/April: 9-18. 

14. Hellinger FJ. The impact of financial incentives on physician behavior in managed care 

plans: a review of the evidence. Medical Care Research and Review. 1996; 53(3): 294-314. 

15.	 T. Gosden, F. Forland, I.S. Kristiansen, et al. Impact of payment method on behaviour of 

primary care physicians: a systematic review” Journal of Health Services Research and 

Policy. 2001;6(1): 44-55; 

16.	 Rice T. Physician payment policies: impacts and implications. Annual Review of Public 

Health. 1997; 18(1): 549-65. 

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Table 1. Percent of Office-Based Physician Visits That Are Capitated, 1996-2000 

1996 1997 1998 1999 2000 

Total 15.5 15.6 15.3 15.5 13.0a,b 

Health Insurance 

Medicare 9.8 11.5 11.2 12.5 10.7 

Private Insurance 20.2 20.0 19.2 17.8 15.8a,b

 Private HMO 33.3 29.2a 30.0 27.9 25.3a,b 

Medicaid 11.8 10.8 12.0 17.3a 10.5a

 Medicaid HMO 23.2 20.0 20.7 25.6a 14.1a,b 

Age in years 

Under 18 21.9 20.6 20.9 18.6a 16.0a,b 

18-64 15.8 16.1 15.4 15.8 12.9a,b

 65 and over 9.7 10.8 11.0 12.6 11.0 

Race/ethnicity 

Hispanic 16.9 

21.7 

18.3 

20.3 

20.4a 

17.6 

20.9 

19.8 

20.0 

13.6a,b 

White and other 14.7 14.9 14.5 14.5 12.2a,b 

Sex 

Male 15.8 16.7 15.3 15.3 13.2a,b 

Female 15.2 14.9 15.3 15.6 12.8a,b 

Perceived Health Status 

Fair/Poor 17.4 17.5 17.3 16.3 13.8a,b

 Good to Excellent 13.8 14.1 13.6 14.8 12.2a 

Poverty Status 

Below 125% of poverty line 

Above 125% of poverty line 

9.2 

17.0 

10.6a 

16.7 

11.5 

16.1 

16.1a 

15.4 

10.4a

13.5a,b 

Region 

Northeast 15.5 14.7 11.5a 15.5a 13.3 

South 10.2 15.4a 11.0a 10.5 8.6a 

Midwest 12.9 12.2 9.7a 9.5 9.5b 

West 24.8 21.7a 31.9a 30.9 23.2a 

Metropolitan Statistical Area (MSA) 

MSA 17.7 18.2 17.9 17.7 14.8a,b 

non-MSA 5.3 5.3 4.7 6.4a 4.6a 

a

Significantly different from previous year at .05 level. 

b

Significantly different from 1996 at .05 level. 

17
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 2. Percent of Hospital Outpatient Department Visits That Are Capitated, 1996-2000 

1996 1997 1998 1999 2000 

Total 7.2 4.2a 7.2a 4.0a 4.5b 

Health Insurance 

Medicare 4.9 4.0 3.4 3.7 3.3

 Private Insurance 10.3 4.7a 10.5a 4.2a 6.6a,b

 Private HMO 19.2 9.6a 18.7a 7.4a 10.2b 

Medicaid 3.1 4.2 4.6 3.9 1.3a

 Medicaid HMO 6.3 6.2a 14.4 6.6 1.9a,b 

Age in years 

Under 18 10.3 5.5a 12.4a 4.9a 6.6b

 18-64 7.9 4.2a 8.6a 4.1a 5.0b

 65 and over 4.9 3.8 3.2 3.7 3.6 

Race/ethnicity 

Hispanic 9.4 3.8a 7.2 7.9 10.4 

Black 4.2 5.5 4.2 3.1 5.8

 White and other 7.4 4.0a 7.6a 3.8a 3.9b 

Sex 

Male 10.5 3.5a 5.2a 3.8a 3.9b

 Female 4.6 4.7 9.0a 4.2a 5.0 

Perceived Health Status 

Fair/Poor 9.1 5.5a 10.7a 4.8a 7.3a

 Good to Excellent 5.9 3.6a 5.5a 3.6a 3.3a 

Poverty Status 

Below 125% of poverty line 

Above 125% of poverty line 

5.4 

7.7 

3.3 

4.4a 

4.2 

7.9a 

5.1 

3.8a 

2.2a

5.0b 

Region 

Northeast 4.8 3.8 3.4 2.8 3.5 

South 5.4 3.3 6.9a 2.4a 1.2b 

Midwest 4.0 2.3a 2.6 1.4 .7a,b 

West 18.2 9.9a 23.1a 15.8a 18.2 

Metropolitan Statistical Area (MSA) 

MSA 8.8 4.8a 8.6a 4.8a 5.7b 

non-MSA 2.0 2.2 2.3 1.2a 1.0b 

a

Significantly different from previous year at .05 level. 

b

Significantly different from 1996 at .05 level. 

18
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 3. Percent of Hospital Emergency Department Visits That Are Capitated, 1996-2000 

1996 1997 1998 1999 2000
 

Total 4.9 3.3a 4.4a 4.4 4.9 

Health Insurance 

Medicare 6.9 4.0 3.4 5.0 5.1

 Private Insurance 6.1 3.9a 5.5a 5.2 6.2

 Private HMO 10.9 6.8a 9.2a 7.8 10.7a 

Medicaid 2.2 3.5 4.9 3.2 4.1

 Medicaid HMO 5.6 7.4 10.0 5.3 5.5 

Age in years 

Under 18 4.3 4.2 3.5 4.5a 4.6 

18-64 5.1 2.6a 5.2a 4.2a 4.7 

65 and over 5.5 4.7 3.1 5.3 6.0 

Race/ethnicity 

Hispanic 

Black 

7.4 

7.3 

4.8 

2.7a 

10.5a 

5.0 

5.9a 

2.7 

9.8 

2.4b 

White and other 4.2 3.2 3.4 4.6 4.8 

Sex 

Male 5.7 3.8a 4.4 4.5 3.9b

 Female 4.2 2.9 4.4a 4.4 5.8 

Perceived Health Status 

Fair/Poor 5.0 3.8a 4.7 4.9 5.0

 Good to Excellent 4.9 2.9a 4.2a 4.1 4.9 

Poverty Status 

Below 125% of poverty line 3.1 1.9 4.7a 4.6 2.9

 Above 125% of poverty line 5.6 3.8a 4.3 4.4 5.6 

Region 

Northeast 5.0 1.0a 1.9 .9a 2.7a,b 

South 3.4 2.0a 3.2 3.0 3.3 

Midwest 3.3 2.8 1.0a 1.3 .4a,b 

West 10.4 8.2 15.4a 17.6 17.6b 

Metropolitan Statistical Area (MSA) 

MSA 5.8 3.8a 5.3a 5.4 5.6 

non-MSA 1.7 1.7 1.6 1.5 2.2 

a

Significantly different from previous year at .05 level. 

b

Significantly different from 1996 at .05 level. 

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Table 4. Percent of Hospital Inpatient Stays 

That Are Capitated, 1996-2000 

1996 1997 1998 1999 2000 

Total 5.5 3.2a 2.3 3.3 4.2a,b 

Health Insurance 

Medicare 5.6 2.7a 1.5 2.0 2.5b 

Private Insurance 6.5 4.5 3.7 5.4 6.9

 Private HMO 9.8 7.3 6.1 9.5 11.8 

Medicaid 2.5 1.5 2.4 2.0 2.5

 Medicaid HMO 6.4 3.5 4.6 4.3 3.5 

Age in years 

Under 18 3.7 3.8 1.4a 2.1 2.9

 18-64 5.8 3.3a 3.0 4.2 5.1

 65 an over 5.6 2.8a 1.7 2.3 3.0b 

Race/ethnicity 

Hispanic 5.8 6.0 3.4a 4.2 4.7

 Black 8.6 1.4a 1.6 2.4 2.1

 White and other 5.0 3.2a 2.3 3.3 4.5a,b 

Sex 

Male 5.5 3.9a 2.6 3.0 3.8b

 Female 5.5 2.7a 2.2 3.5 4.5a,b 

Perceived Health Status 

Fair/Poor 

Good to Excellent 

5.0 

5.7 

4.4 

2.7a 

2.7 

2.2 

4.6 

2.8 

4.4

4.1a,b 

Poverty Status 

Below 125% of poverty line 

Above 125% of poverty line 

4.0 

6.0 

2.1a 

3.6a 

2.5 

2.3 

2.1 

3.6 

3.2b

4.5a,b 

Region 

Northeast 2.4 .4a 1.9a 1.3 3.8a 

South 3.7 1.8 1.6 1.0 1.7 

Midwest 3.7 2.5a .3a .5a .9b 

West 14.6 8.9a 8.5 14.4 14.8 

Metropolitan Statistical Area (MSA) 

MSA 6.4 3.9a 3.1 4.5 5.1b 

non-MSA 2.4 1.7 .5 .5 .9 

a

Significantly different from previous year at .05 level. 

b

Significantly different from 1996 at .05 level. 

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