A payment structure in which an HMO pre-pays a provider a flat amount for each member's medical care, usually on a monthly basis.

Capitation is a method of payment from the HMO to the primary care physician. The payment is not for services rendered, but to the number of members who have chosen that doctor as their PCP.

A method of payment used in managed care in which doctors or hospitals are paid a fixed amount for each person cared for, regardless of the actual number or type of services they deliver.

The annual fee paid to a physician or group of physicians by each participant in a health plan.

Fixed per patient payments made in advance each month to health plans or providers in return for delivering necessary healthcare services. This payment method (versus fee-for-service) is used by governments, insurers, and managed care organizations to control health care costs.

Involves a prepaid amount per month to the provider per covered member (PMPM).

A fixed payment that an HMO pays to a physician, group practice, hospital or network of providers. The payment is calculated to cover the expected costs of providing certain services to members over a period of time, usually a month. The provider gets the same payment each month (or other fixed time period), regardless of the amount or type of services actually rendered. capitation payment systems can cover just the cost of providing primary care (primary care capitation), may cover the costs of primary care and some specialty care (partial capitation) or may also include the costs of primary, specialty and hospitalization (full or global capitation).

The capitation fee is a fixed sum that all students must pay to become members of the student union and other student societies and clubs at their institution.

A per-member monthly payment to a provider that covers contracted services and is paid in advance of the services' delivery. In essence, a provider agrees to provide specified services to HMO members for this fixed, predetermined payment for a specified length of time (usually a year), regardless of how many times the member uses the service. The rate can be fixed for all members or it can be adjusted for the age and sex of the member, based on actuarial projections of medical utilization. Back to the top of the page

A method of paying for services based on a flat rate regardless of the number of people using that service. A fee paid per-member-per-month (pmpm) is an example.

The term used for HMO health insurance companies' fixed payment per patient per month to a primary care physician, instead of paying a specified amount for specific procedures. According to Dr. Wattenburg, a typical capitation payment is $11/month, with which the doctor must pay for all of his time, tests, and procedures performed. Webster's defines capitation as "a tax or fee upon head of each person".

The payment of a per capita amount for a defined package of health care services. A specific dollar amount per member per month is paid to providers or organizations of providers for which they provide specific services, regardless of the quantity of services necessary to meet the health needs of the defined population.

A method of paying physicians or other providers a set amount of money for the care of patients, rather than paying for each procedure performed.

Fees paid to providers based on the number of patients they serve on behalf of a benefits plan.

a tax levied on the basis of a fixed amount per person

A fixed predetermined amount paid to a provider for each person served, without regard to the actual number or nature of services provided to each person in a set period of time. Capitation is the characteristic payment method in health maintenance organizations.

A compensation plan used in some health maintenance organizations (HMOs) in which a physician is paid a flat amount per year per subscriber who elected to use that physician. For that amount, the physician must treat the subscriber as often as necessary during that year. Physicians are not reimbursed for services that exceed the allotted amount.

A Capitation is a fixed dollar amount per plan member per month paid to providers regardless of medical utilization. The payment structure shifts the financial risk from the insurance company to the physician or hospital accepting payment. Physicians and hospitals buy stop loss to limit any potential catastrophic medical financial loss on any one member per year.

A type of reimbursement in which providers are paid a fixed per-capita amount to provide all health care services required by each patient under their care.

A payment method in which a health plan pays a hospital or physician a fixed amount per patient, regardless of the amount or types of services the patient requires.

A method of paying for health care services on the basis of the number of patients who are covered for specific services over a specified period of time rather than the cost or number of services that are actually provided.

A reimbursement method where a fixed payment amount per member enrolled in a managed care plan, per a certain period of time, is paid to a health care provider. The provider is responsible for delivering or arranging the delivery of all health services required for the covered person under the condition of the provider contract.

A method of paying for medical services on a per-person rather than a per-procedure basis. Under capitation, an HMO pays a participating doctor a fixed, predetermined amount in advance of the delivery of service for every HMO member he or she takes care of, regardless of how many times the member uses the service.

Method of payment to Providers where a set amount per covered person is paid, regardless of the level or type of care provided

A payment method in which the health care provider is paid a set dollar amount determined by a per-member, per-month (pmpm) calculation to deliver medical services to a specified group of people.

A rate that is paid to a specific health care provider. In exchange, this provider agrees to provide care services for patients covered by this plan.

A stipulated dollar amount established to cover the cost of health care delivered to a person. The term often refers to a negotiated per capita rate to be prepaid, usually monthly, to a health care provider. It is often coupled with mechanisms that set an upper limit on risk assumed by a provider. The provider is responsible for delivering, or arranging for the delivery of, all health services required by the covered person under the conditions of the carrier-provider contract.

Method of paying health care providers or insurers in which a fixed amount is paid per enrollee to cover a defined set of services over a specified period, regardless of actual services provided.

is a dollar amount established to cover the cost of all health care services delivered per person during a specified period of time.  This term may refer to either the amount paid to a managed care organization by its private and public sector clients or a negotiated per capita rate to be paid periodically to a health care provider by a managed care organization.

The payment per member, per month by the insurance plan to a physician or facility for providing contracted services to managed care patients. The PCP or specialist/facility is paid the same regardless of whether a member receives services or not. As a result, the health care providers assume some financial responsibility for managing the members care. Failure to properly manage these members can result in financial loss for the physician group.

A method of paying for health services that is based on the number of patients who are covered for certain services for a set period rather than by the number or cost of services actually provided.

A method of insurance reimbursement in dental benefit plans which requires that the dentist provides all necessary covered services to eligible plan members for a fixed capita monthly payment, usually paid regardless of the services rendered. The financial risk is assumed by the dentist in these plans.

A fixed periodic fee paid to a healthcare provider by a healthcare carrier for each covered member eligible to receive healthcare services under the terms of an HMO-type plan, regardless of how many times the member uses the service.

A set dollar payment per beneficiary, per unit of time (usually a month) that is paid to cover a specified set of services and administrative costs without regard to the actual number or the cost of services provided. (See dual-risk capitation, full-risk capitation, and shared-risk capitation).

A dollar amount established to cover the cost of all health care services delivered per person during a specified period of time. This term may refer to either the amount paid to an MCO by its private and public sector clients or a negotiated per capita rate to be paid periodically to a health care provider by an MCO. The MCO or provider is then responsible for delivering or arranging the delivery of all health services required by the covered person under the conditions of the contract.

A dental benefit program in which a network dentist agrees to provide all or most covered dental services to those who enroll with his/her office. The carrier pays the network dentist on a per-person basis rather than per service. See "DHMO."

System whereby a specific dollar amount is allotted to cover the cost of all health care delivered to a person within a specified time period.

A rate paid, usually monthly, to a health care provider. In return, the provider agrees to deliver the health services agreed upon to any covered person.

A method of payment to providers used in managed care.

the fixed or set dollar payment cap that a consumer or employer pays to a health maintenance organization (HMO), for the services being offered by a health maintenance provider regardless of usage levels. Providers are health care professionals who assist patients. Typically providers select doctors, physicians, hospitals, or professional health care givers. The term can also be applied to nurses, nurse practitioners, chiropractors, psychologists, and other health care professionals who practice in specialized fields of medicine.

A method of payment for health services often found in health maintenance organizations and preferred provider organizations. A provider is paid a fixed amount for each person served for a period of time, without regard to the number or nature of the services provided to each person.

Method of payment for health services in which a dentist or specialist is paid a fixed amount for each person served regardless of the number or nature of services provided to each person, usually associated with a prepaid/HMO.

The method of payment in which the provider is paid a fixed amount for each person served no matter the number or nature of services delivered.

A system where an HMO pays a doctor or hospital a flat monthly fee for the care of each health plan member whether or not any services are delivered.

A payment method under which a provider of healthcare services is paid a pre-determined dollar amount per member, per month (PMPM), to render services without regard to the type, frequency or cost of services rendered to the individual.

A method of payment for health services in which a physician or hospital is paid a fixed, per capita amount for each person served regardless of the actual number of services provided to each person.

A capitation program is one in which a dentist or dentists contract with programs' sponsor or administrator to provide all or most of the dental services covered under the program to subscribers in return for payment on a per-capita basis. Dental plans

Fixed monthly fee paid to an insurance company in exchange for full care if an individual.

A method of health care financing and delivery which pays a fixed amount of money per member for a specified set of services for a specified time.

A fixed fee paid to a provider for each participant in a group plan. Usually the provider is given a maximum amount of money per person no matter how many or few services are used.

is the payment of a fixed dollar amount, per person, for the provision of a defined set of health services to a defined population for a specified period of time (eg. one month). Capitation is a fixed revenue system that pays the same amount each month no matter how many or how few services are actually provided.

A payment system in which fees are paid per person or "per capita" and a primary care provider is financially responsible for coordinating patient care within the fees or capitated rate for all his/her patients. Capitation means a provider is given a maximum amount of money per person no matter how many or how few services are provided.

A method of financing health care services that provides a fixed, per-person amount that a health provider/provider organization is paid for a given time period (usually a year), regardless of the amount of services provided, but with expected client outcomes.

A dollar amount established to cover the cost of health care services delivered for a person during a specified length of time. The term usually refers to a negotiated per capita rate to be paid periodically to a health care provider by a MCO. The provider is then responsible for delivering or arranging the delivery of all health services required by the covered person under the conditions of the provider contract. This term may also refer to the amount paid to a MCO by HCFA or a State.

A payment arrangement in which a health plan pays a doctor or practice a fixed, per-patient fee (usually monthly or quarterly). The doctors are expected to use the resulting money "pool" to cover all of the plan's patients' needs, from exams to referrals to specialists. If there's money left over, the physicians profit. If not, they may be forced to absorb part of the extra cost.

Method of payment for health services in which a health care provider is paid a fixed amount for each person served regardless of the actual services provided.

A dental benefit program in which a network dentist agrees to provide all or most covered dental services to those who enroll with his/her office. The carrier pays the network dentist per capita (for each enrolled patient) rather than per service.

Capitation represents a set dollar limit that you or your employer pay to a health maintenance organization (HMO), regardless of how much you use (or don't use) the services offered by the health maintenance providers. (Providers is a term used for health professionals who provide care. Usually providers refer to doctors or hospitals. Sometimes the term also refers to nurse practitioners, chiropractors and other health professionals who offer specialized services.)

A method of payment for health care services in which providers are paid a fixed monthly rate for each plan member they have as a patient regardless of the amount of care the member receives.

Providers are paid a fixed amount each month (orother negotiated time period) for providing services on a per-person (or"capitated" as in "head count") basis. The paymentamount does not depend on the amount of care or service provided. Thistype of payment to providers is rapidly spreading throughout the UnitedStates, and is the main payment method used in health maintenanceorganizations (HMOs).

A method of paying for medical services on a per-person rather than a per-procedure basis. Under capitation, an insurance company pays a participating doctor a fixed amount per month for every member who is his or her patient, regardless of how much or how little care the member receives.

A reimbursement system in which healthcare providers receive a fixed fee for every patient served, regardless of how many or few services the patient uses. For example, an insurer negotiates to pay a Physician $100.00 a month to care for each of its subscribers, regardless of the amount of services each subscriber uses.

The fee an insurance organization occasionally pays to a health care provider or facility for medical services. Usually providers are paid a per-member, per-month fee to accept these patients or provide this type of service to patients.

A payment methodology in which the physician is paid a set dollar amount determined by a per member per month calculation to deliver medical services to a specified group of people. back to the top

A specified amount of money paid to a health plan or doctor. This is used to cover the cost of a health plan member's health care services for a specific length of time.

Financial arrangement in which health plans pay medical groups and/or doctors a fixed amount for each member, typically on a monthly basis. This amount remains exactly the same whether the member uses the medical group or doctor, or not.

A fee payment method used by some health maintenance organizations (HMOs) under which the HMO prepays a medical care provider a flat amount for each subscriber's medical careæusually on a monthly basis.

The establishment of a fixed amount of payment for services for a discrete number of persons during a specified period of time. It involves shared risk between the payer and provider of care.

health insurance payment mechanism in which the provider automatically receives a fixed payment per enrollee over a specified period to cover a defined set of services, regardless of actual services provided.

A per-member monthly payment to a provider that covers contracted services and is actuarially determined on the basis of costs expected to be incurred. This is an alternative to the fee-for-service arrangement.

A method of payment for health care services in which the provider accepts a fixed amount of payment per subscriber per period of time, in return for providing specified services.

One of the following: The method of payment in which the provider is paid a fixed amount for a patient over a given period no matter what the actual number or nature of services delivered. Providers are not reimbursed for services that exceed the allotted amount. The rate may be fixed for all members or it can be adjusted for the age and gender of the member, based on actuarial projections of medical utilization. The cost of providing an individual with a specific set of services over a set period of time, usually a month or a year.

A per-member, per-month payment (PMPM) to a health care provider or health plan for each member enrolled, regardless of the amount of care a member requires.

A method of paying for medical services on a per-person rather than a per-procedure basis. Under capitation, an HMO pays a doctor a fixed amount each month to take care of HMO members, regardless of how much or how little care each member needs.

A method of paying for health care services. A fixed amount per person guarantees access to specified medical services, whether plan members take advantage of them or not.

A contracted payment that a physician receives from an insurance company for providing health care. This payment is usually a set amount per member per month. The physician is paid whether or not the patient receives medical services.

A method of paying for medical services on a per-person rather than a per-procedure basis. Under capitation, an HMO pays a participating doctor a fixed amount per month for every HMO member he or she takes care of, regardless of how much or how little care the member receives.

A set dollar amount that you or your employer pays to a health maintenance organization (HMO), regardless of how much you use (or don't use) the services offered by the HMO's providers.

A fixed amount of money paid per person for covered services for a specific time; usually expressed in units of per member per month (pmpm).

A flat monthly fee that a health plan pays to a provider (doctor, hospital, lab, etc.) to take care of a patient's needs. Capitation is part of the provider-reimbursement mechanism.

The prepaid amount which the provider receives as compensation for Capitation Services.

Capitation represents a set dollar limit that your health maintanence organization (HMO) pays to your primary care physician for providing medical treatment to you and your dependents. This fee is usually paid to the physician on a monthly basis. The physician gets no more nor no less than this set fee no matter how much you use his or her services.

Capitation represents a set dollar limit that you or your employer pay to a health maintenance organization (HMO) regardless of how much you use the services offered by the health maintenance providers. Provider is a term which usually refers to the doctors or hospital.

A method of paying medical providers through a pre-paid, flat monthly fee for each covered person. The payment is independent of the number of services received or the costs incurred by a provider in furnishing those services.

A form of compensation used primarily by health maintenance organizations (HMOs) to pay providers a periodic fee (usually a per-member/ per-month fee) in return for delivering as much necessary health care services as the insured might need.

Method of payment whereby a physician or hospital is paid a fixed amount for each person in a particular plan regardless of the frequency or type of service provided.

In managed-care plans, a system of prepaying doctors and hospitals a set of fee to provide health care for each enrollee, without regard to the type or number of services rendered.

Method of payment for health services in which a physician or hospital is paid a fixed amount for each enrollee regardless of the actual amount or type of services provided to each person. The provider is responsible for delivering or arranging for the delivery of all health services required by the covered person under the conditions of the provider contract.

also Capitated Rates. Fixed, pre-determined amount of money paid to a health care provider or plan for each member or enrolled family unit. The provider or plan agrees to deliver all care during a fixed time for this pre-determined amount of money, regardless of the services the member uses.