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John M. Neff, MD; Gerard Anderson, PhD

JAMA. 1995;274(23):1866-1869.

Abstract
Health care for children with chronic illnesses is significantly more expensive than for the average child. Children with chronic illnesses are especially vulnerable in a competitive health care environment because of the higher ongoing cost associated with treating their illnesses and the inherent pressures to reduce services to manage within the capitated rate. To minimize the adverse impact a competitive market could have on these children, a "carve-out" for specific medical conditions is discussed. A capitation pricing system that reflects their higher costs is proposed, as well as a delivery system that is focused on their needs.

(JAMA. 1995;274:1866-1869)

Author Affiliations
From the Children's Hospital and Medical Center, Seattle, Wash (Dr Neff), and the Department of Pediatrics at the University of Washington, Seattle, and The Center for Hospital Finance Management at the Johns Hopkins Health Institution, Baltimore, Md (Dr Anderson).

Footnotes
Reprint requests to Children's Hospital and Medical Center, 4800 Sand Point Way NE, PO Box 5371, Seattle, WA 98105-0371 (Dr Neff).

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