Capitation
Pronunciation: kap-ih-TAY-shun
A dental insurance payment model in which a dentist receives a fixed per-patient fee per period, regardless of services rendered.
Full Definition
Capitation is a managed-care reimbursement structure in which an insurer pays a participating dentist a set monthly or annual fee for each enrolled patient, irrespective of how many or how few procedures that patient requires. This contrasts with fee-for-service models where payment is tied to each procedure performed. In editorial contexts, the term appears in managed care contracts, dental HMO (DHMO) documents, and practice management analyses. Editors should not conflate it with a 'copayment' or 'coinsurance' structure, as no per-procedure billing occurs under a pure capitation arrangement.
Usage
Usage note: Distinguish carefully from fee-for-service; the two are mutually exclusive payment structures in dental benefit plan documents.
In Context
- "Under the capitation agreement, the practice received $18 per enrolled member per month regardless of utilisation." — Managed care contract
- "The report incorrectly described the DHMO plan as fee-for-service; it operates on a capitation model." — Practice management analysis