A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services?
a. Prospective payment system
b. Retrospective payment system
c. Single-payer system
d. Capitation
ANS: D
Correct: Capitation is a method of reimbursing providers (usually, primary care providers such as physicians or nurse practitioners) in which the insurance company pays the provider a set amount of money each month to provide a defined set of health care services under this plan. Payment is generally received as a per-member–per-month payment. Defined health care services generally include preventive, diagnostic, and treatment services.
Incorrect:
a. A prospective payment system is a method of reimbursing health care providers in which the total amount of payment for care is predetermined on the basis of the client's diagnosis.
b. A retrospective payment system is a method of reimbursing health care providers in which professional services are rendered and charges are billed according to each service provided.
c. The single payer system is a method of reimbursement whereby one payer, usually the government, pays all health care expenses for all citizens with the use of funding acquired through taxes.
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