The evolution of the Department of the Navy's capitation-based resource allocation model and its impact on resource management at Navy medical treatment facilities

摘要

In 1994, DoD implemented managed care and a capitation-based resource allocation model within the Military Health Services System (MHSS). This study examines the evolution of DoD's model and its impact on resource managers. Personal and telephonic interviews were conducted with key individuals from the Office of the Secretary of Defense for Health Affairs (OASD(HA)), Bureau of Medicine and Surgery (BUMED), and at the Military Treatment Facility (MTF) level. A review of literature, including books, white papers, monographs, and journal articles were undertaken. The thesis concludes that the capitation methodology that OASD(HA) and the Services follow is a population-based model. BUMED allocates Defense Health Program (DHP) fluids on the basis of capitation categories down to the activity level. However, the MTF resource manager apportions DHP fluids to the departments based on historical and workload considerations. Due to a lack of a patient cost accounting module in the present accounting system, actual execution against a capitated resource allocation is not possible. Because of other limitations in the present structure, MTFs under BUMED still use traditional incremental budgeting in allocating fluids to their various departments. Thus, the adoption and implementation of a capitated-based financing system had limited impact on resource management at the activity level.