Date of Award

Fall 2019

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Ronnie Horner


We report on a study of the comparison of two reimbursement methods, capitation (CAP) and fee for service (FFS), as well as mixed payment, with respect to the implementation of the ADA recommendations for Diabetes Type 2 (DM2) management and referral rates for specialist health care in the outpatient setting of the United States.

Our purpose in examining these specific topics is to determine whether there is any difference in the implementation of the ADA recommendations or the frequency of referral between visits paid under CAP vs under FFS because both quality and cost of healthcare is affected by these two payment types. We applied Agency Theory combined with Donabedian’s Theory to these topics as it relates to behavioral change in response to financial incentives. Our sample was a pooled cross-section of data from the 2014 and 2015 National Ambulatory Medical Care Surveys (NAMCS). We analyzed the weighted data using both patient, physician, and payer characteristics We hypothesized that visits that were paid under CAP would be less likely to implement ADA recommendations in the management of DM2 and more likely to be referred to specialists than those paid under FFS. Our analysis regression tested our hypotheses and the results demonstrated that the estimated average of applying ADA recommendations for visits under CAP is 0.5 recommendations less than visits under FFS (P


© 2019, Abdullah Alharbi