A uniform payment based on the number of people in the population being served. The health or mental health care provider, or group of providers, accepts responsibility to deliver the health or mental health services needed by all members of a specified group, and an agreed-on payment is made at regular intervals to the provider. The payment is made even if no services have been given, but the payment is no greater than the agreed-on amount even if more extensive services have been provided.
A method of paying health providers based, on the number of patients involved rather than on a fee for service basis.
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount for each person served without regard to the actual number or nature of services provided to each person. Capitation is characteristic of health maintenance organizations but unusual for physicians. Also, a method of Federal support of health professional schools authorized by the Comprehensive Health Manpower Training Act of 1971, P.L. 92-157, and the Nurse Training Act of 1971, P.L. 92-158 (sections 770 and 810 of the PHS Act), in which each eligible school receives a fixed capitation payment from the Federal government for each student enrolled, called a capitation grant.
Capitation is a flat periodic payment to a physician or health care system per person cared-for (“per capita”). The provider assumes the risk that the payment will cover the costs for whatever the patient needs. Careful actuarial study beforehand in determining the amount of the fee makes this far less of a gamble than might be thought. Capitation has probably the lowest administrative cost of any payment mechanism.
Payment mechanism in which a provider is paid, in advance, a set fee for medical services regardless of the amount or intensity of medical services rendered to a patient.
A method of payment for health care services. In capitation, a fixed payment is made for a specific period (monthly or annually) for each person assigned to a physician, hospital, or other health care provider, regardless of t he number and nature of services provided.
A form of reimbursement for health care services in which the health insurer assigns a finite number of patients to the care of a subcontracting provider. The health care provider is paid a predetermined amount for each patient enrolled in his or her care. This arrangement provides incentives to the provider to limit health care costs, by placing the provider at financial risk if the cost of care provided exceeds the payment received.