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Risk-based capitation payments for health care: a survey of the literature.

Rossiter Lf

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Abstract

This article provides a synthesis of the literature on risk-based capitation payments for health services and a framework for understanding rate-setting methods. Benefits, timing, integration, and risk are explained as four basic dimensions of risk-based capitation payments that must be understood in setting payment rates. Issues in health care policy are explored, with an emphasis on approaches to setting payment rates. The article is intended for classroom use in courses in health economics, health insurance, health maintenance organizations, or alternative financing and delivery systems.

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What this paper is about

This article provides a synthesis of the literature on risk-based capitation payments for health services and a framework for understanding rate-setting methods. Benefits, timing, integration, and risk are explained as four basic dimensions of risk-based capitation payments that must be understood in setting payment rates. Issues in health care policy are explored, with an emphasis on approaches to setting payment rates. The article is intended for classroom use in courses in health economics, health insurance, health maintenance organizations, or alternative financing and delivery systems.

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Available abstract

This article provides a synthesis of the literature on risk-based capitation payments for health services and a framework for understanding rate-setting methods. Benefits, timing, integration, and risk are explained as four basic dimensions of risk-based capitation payments that must be understood in setting payment rates. Issues in health care policy are explored, with an emphasis on approaches to setting payment rates. The article is intended for classroom use in courses in health economics, health insurance, health maintenance organizations, or alternative financing and delivery systems.

Key concepts: Capitation, Payment, Actuarial science, Business, Health care, Capitation fee, Public economics, Finance

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