CAPITATION

JOKO MULYANTO
DEPARTMENT OF PUBLIC HEALTH AND COMMUNITY MEDICINE
FACULTY OF MEDICINE AND HEALTH SCIENCES
UNIVERSITAS JENDERAL SOEDIRMAN
OUTLINE

• Definition
• Type
• Components
• Method
WHAT IS CAPITATION

• Type of provider payment system, in which provider paid in advance, a predetermined fixed rate, to
provide a defined set of services for each individual enrolled with the provider for fixed period.
• Capitation mostly used as payment system at Primary Health Care (PHC) for outpatient services
TYPE OF CAPITATION

• Base-rated capitation
• Risk-adjusted capitation
• Capitation with suplemental incentives
COMPONENT OF CAPITATION

• Package of Services
• Base capita- rated
• Number of individual enrolled in each provider
PACKAGE OF SERVICES

• A defined healthcare services that provider must provide to beneficiaries.

• Usually range of services that provided in primary health care
• Such as: Medical consultation, drugs, simple medical procedure, simple laboratory or supporting
examination
• Promotive and preventive services
BASE-CAPITA RATED

• Unit cost for each services

• Utilization rate for each services
NUMBER OF INDIVIDUALS

• Total number of individuals enrolled for each provider.

METHOD TO CALCULATE CAPITATION RATE

• Package of service : Outpatient medical service includieng, medical consultation, drugs, simple
supporting examination (routine blood count), simple medical procedure (i.e : minor surgery)
• Unit cost for each services and utilization rate for each services
• Total number of individual, for example : 30.000
• Non medical service
THANK YOU

@jkmulyanto