IN 1 PARAGRAPH PLEASE BUILD ON CLASSMATE RESPONSE. Please include reference if needed.
Capitation is a payment system in which the entity financially responsible for the patient’s healthcare services receives a fixed periodic sum for each patient (per capita) that covers the costs of utilization by the patient; the sum can be adjusted for specific patient characteristics, such as age and gender (Hicks, 2020). These are the primary financial resources that health insurance payers have access to keep an eye on, evaluate, and control the behavior of healthcare providers both before and after services are provided.
Overall case management, preadmission management, contemporaneous management, and post-hospital review are the several forms of management that are mentioned (Hicks, 2020). Each of these measures entails the establishment of standards and the evaluation of patients considering these standards. In essence, pay for performance is when an incentive is given for completing tasks well. This influences commercial and economic success by encouraging healthcare organizations to pursue excellence.
Primary care clinics or urgent care centers are one type of HMO that might use this; in such cases, they would refer the patient to another doctor for any necessary follow-up care or specific diagnosis. Health insurance payers have a wealth of financial tools to keep an eye on, evaluate, and control the conduct of healthcare providers. Ultimately, though, the hospital or provider must be able to give every patient the proper care, considering their condition and demographic.
References:
Lanis Hicks. 2020. Economics of Health and Medical Care. 7th edition Jones & Bartlett textbook