Service Covered Under Capitation Agreement

The amount of the capita is determined in part by the number of services provided and varies from one health plan to another. Most capitation payment plans for basic services cover critical areas of health care. In the absence of induced inefficiencies, suppliers could pass on part of their risk premiums to reinsurers, but the premiums that suppliers should receive would exceed those that could be charged by companies that pass on risks in competitive insurance markets. [4] [5] [8] Reinsurers are cautious about contracting with physicians because they believe that if providers believe they can collect more than they pay in premiums, they would tend to return to the same excesses that are encouraged by pay-per-service systems. Capitation payments are defined periodic payments, per patient (usually monthly) for each person enrolled in a capitular insurance plan. It is obvious that this exposes the family doctor to a higher financial risk if the total cost of transfers exceeds the amount of capitation, but the potential financial rewards are also greater when diagnostic transfers and outsourcing services are controlled. In addition, some test recommendation plans and sub-services are paid through fee for service agreements, but are usually paid through contractual scales that are reduced by 10% to 30% compared to usual and usual local fees. Replace existing methods with a form of capita that pays care groups directly to cover all of a person`s health needs for a set period of time. This would significantly reduce the role of pure insurers. The Intermountain non-profit health system has shown that this approach works. Under a capitulation contract, the health care provider receives a set amount of dollars per month to see patients, regardless of the number of treatments or how often the doctor or clinic sees the patient. It has been agreed that the supplier will receive a fixed deposit agreed in advance per month.

Whether or not the patient needs services in a given month, the provider always receives the same fee. The more treatment a patient needs, the less money a healthcare provider earns per treatment…

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