Terms for how health systems raise and pool funds, insure populations and pay providers.
Capitation is a provider-payment method that pays a predetermined amount per enrolled or attributed person for a defined period and service package, regardless of the number of covered services that person uses during the period.
A methodology reimbursing a provider a predetermined amount based on a patient's diagnosis category, rather than the specific services delivered.
Catastrophic health expenditure occurs when a household's out-of-pocket health spending exceeds a specified share of its available resources.
Coinsurance is the percentage of the allowed cost of a covered healthcare service that an insured person pays under the plan's cost-sharing rules, commonly after satisfying the applicable deductible.
A method setting premiums that charges all enrollees within a community the same rate, or within narrow limits, regardless of individual risk.
A cost-sharing form in which an insured person pays a fixed sum for a covered service, unlike coinsurance's percentage-based payment.
The general term for the portion of healthcare costs an insured person pays directly, covering deductibles, copayments, and coinsurance.
A practice where an insurer or provider selectively attracts healthier, lower-cost enrollees while avoiding sicker ones, undermining risk pooling.