Fundamentos de Accidente y SaludPregunta 481 de 716
Under a 'capitation' payment arrangement, an HMO pays a network physician:
a.A fixed amount per enrolled member per month that never varies with the services used
b.Nothing at all until the enrolled patient files a claim form after each visit
c.A single lump-sum payment only at the end of the calendar year based on total enrollment
d.A separate negotiated fee for each individual office visit, test, or procedure performed for a member
Explicación
Under capitation, the HMO pays the physician a set amount for each enrolled member per month (per capita), whether or not that member seeks care, which shifts some financial risk to the provider and encourages efficient, preventive care. It is the opposite of fee-for-service, which pays per service. It is not a claim-triggered or year-end-only payment. Capitation is a hallmark of the HMO managed care model.
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Revisado por John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verificar)