What is capitation in the context of healthcare payment?

Capitation is correctly defined as a fixed payment amount per member that does not vary by services rendered. This payment model is designed to provide a set fee to healthcare providers for each enrolled patient over a specific period, usually monthly, regardless of the number of services the patient utilizes during that time. This approach incentivizes providers to focus on preventative care and efficient management of patient health, as their payment remains constant whether the patient sees them frequently or only occasionally.

In this model, capitation shifts some financial risk to healthcare providers, encouraging them to manage their patient populations more effectively while maintaining quality care. It contrasts with fee-for-service models, where providers receive payments based on the volume and type of services rendered, potentially leading to unnecessary tests or procedures.

The other options do not accurately capture the essence of capitation. A payment based on the number of patients served may suggest a volume-based approach, which is not the fixed nature of capitation. Reimbursement for outpatient care may occur through various methods, and a charge based on the complexity of cases indicates an evaluation-dependent payment system, which again differs from the fixed nature of capitation.