Table 1 Framework for the characteristics of capitation payment mechanism
Attribute | Definition | Levels |
|---|---|---|
1. Adequacy or sufficiency of the payment rate | The extent to which the payment rate covers the costs of services purchased | Adequate Inadequate |
2. Predictability of payment amounts | Whether providers know what amount to expect | Predictable Unpredictable |
3. Predictability of payment patterns | Whether providers know when they will get paid | Predictable Unpredictable |
4. Complexity of the accountability mechanisms associated with the PPM | The complexity of the accountability and reporting mechanisms associated with the PPM | Simple accountability requirements Complex/burdensome accountability requirements |
5. Service coverage of the PPM | The range of services the PPM is paying for | Outpatient services, inpatients services, dental, optical, surgical, nursing care |
6. The performance requirements of the PPM | Whether the PPM is tied to performance | Payments tied to performance Payments not tied to performance |
7. Flexibility or autonomy of the PPM | Autonomy health care providers have to spend or use the PPM funds on anything | Autonomous (Flexible) Restricted (Rigid) |