What type of capitation system involves full risk for all medical expenses?

In a global capitation system, healthcare providers receive a fixed payment per patient for a defined period, such as a month or a year, covering all medical expenses associated with the patient’s care. This payment structure means that providers assume full financial risk for all services rendered to the patient, including preventive care, specialty services, and emergency care. The incentive for providers is to manage costs while ensuring that quality care is provided, as they benefit financially from keeping expenses below the fixed payment they receive.

This payment model contrasts with partial capitation or shared capitation systems, where not all services are included. In partial capitation, providers might only be responsible for certain types of care, such as outpatient or preventive services, while shared capitation often involves risk-sharing arrangements where providers and insurers split the financial responsibility for different services. In a limited capitation system, the scope of services covered under the capitation agreement is restricted even further, focusing on only a select number of medical expenses.

The global capitation system promotes comprehensive care management and encourages providers to prioritize patient wellness and preventive strategies, which can lead to better long-term health outcomes.