Does paying doctors and provider organizations a fixed budget to cover a group of patients cause them to withhold some care so they won’t lose money?

Background Information

Debate Question:This is what a short summary question would look like.

An alternative to paying providers a fee for each test or procedure performed is to pay a fixed amount for a doctor or health system to care for a specified patient population (“capitation”). Such payment systems gradually have been replacing fee-for-service (FFS) methods through managed care organizations, accountable care organizations, and other entities. Organizations that spend less than expected on patient care will make more profit or surplus, while those with higher treatment expenses will make less money.
in favor
against

Capitation provides an incentive to withhold care, since every treatment comes out of the provider’s income. 

Zetema PanelistZetema Panelist In Favor
  • +3 Good Point

Capitation removes the incentive to “overtreat” patients to increase income. Years of experience with capitation hasn’t found any evidence of systematic withholding of care. 

Zetema PanelistZetema Panelist Against
  • Good Point +2

Historically, a capitation approach has caused providers to avoid responsibility for the most costly (sicker) patients.

Zetema PanelistZetema Panelist In Favor
  • +3 Good Point

Payment can be risk-adjusted to compensate providers who care for sicker, higher-cost patients.

Zetema PanelistZetema Panelist Against
  • Good Point +3

Capitation may cause gatekeeping around more expensive services, decreasing access to specialty care.

Zetema PanelistZetema Panelist In Favor
  • +2 Good Point

Gatekeeping often encourages patients to get more appropriate primary care and prevents use of unneeded services. This just corrects the excesses of FFS.

Zetema PanelistZetema Panelist Against
  • Good Point +2

There is mixed evidence about whether capitation actually results in better outcomes.

Zetema PanelistZetema Panelist In Favor
  • +2 Good Point

There’s little evidence that capitation makes outcomes worse. If it saves money without affecting outcomes either way, that’s great. 

Zetema PanelistZetema Panelist Against
  • Good Point +2

Capitation puts the economic interests of health systems at odds with the well-being of the patients they serve. 

Zetema PanelistZetema Panelist In Favor
  • +2 Good Point

Capitation provides health systems with the flexibility to deliver the best and most cost-effective care. Notably, many of the nation’s best healthcare systems welcome capitation. 

Zetema PanelistZetema Panelist Against
  • Good Point +2

What do you think?

Does paying doctors and provider organizations a fixed budget to cover a group of patients cause them to withhold some care so they won’t lose money?

Does paying doctors and provider organizations a fixed budget to cover a group of patients cause them to withhold some care so they won’t lose money?

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