What is Capitation?

Capitation is a payment arrangement where healthcare providers receive a set amount of money per patient per period (usually monthly) regardless of how many services the patient uses. This fixed payment covers all or specific categories of care for enrolled patients, shifting financial risk from insurers to providers and incentivizing efficient, preventive care rather than volume-based services.

Why capitation matters

• Encourages preventive care: Providers are motivated to keep patients healthy to minimize costly treatments
• Controls healthcare costs: Creates predictable expenses for insurers and encourages efficient resource use
• Aligns provider incentives: Shifts focus from quantity to quality of care by rewarding health maintenance

How Solace can help

A Solace advocate can help you understand how capitation affects your care options, ensure you receive necessary services under capitated arrangements, and navigate any limitations in access to specialists or treatments. Advocates can also assist if you feel your care is being restricted due to capitation arrangements.

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