Define: Capitation

Capitation is a payment model where healthcare providers receive a fixed amount of money per patient, regardless of the services provided or the actual cost of care.

Yes, capitation is a legal payment model that is commonly used in healthcare reimbursement.

Capitation can incentivise healthcare providers to deliver cost-effective care and manage resources efficiently, as they receive a fixed payment regardless of the actual cost of care.

There is a potential risk of underutilization of healthcare services under capitation, as providers may be motivated to limit the services provided in order to maximise their profits. However, regulations and oversight are in place to prevent excessive underutilization.

Yes, there are regulations in place to ensure that capitation payments are fair and do not result in inadequate care. These regulations vary by jurisdiction and are typically enforced by government agencies or healthcare regulatory bodies.

Capitation can be used in various healthcare settings, including primary care, specialty care, and managed care organisations. However, its implementation may vary depending on the specific healthcare system and payment arrangements.

Yes, capitation payments can be adjusted periodically to account for changes in patient population, healthcare costs, or other relevant factors. These adjustments are typically agreed upon in the contract between the provider and the payer.

There is a potential risk that, under capitation, patients may receive inadequate or limited care if providers prioritise cost containment over quality. However, regulatory oversight and quality assurance measures aim to mitigate these risks.

Healthcare providers generally have the choice to participate or not in capitation arrangements. However, in some healthcare systems or insurance networks, participation may be a requirement for providers to be included in the network and receive patients from the payer.