A patient tells a nurse, "I belong to a health maintenance organization (HMO) that advertises being a capitated system. What does that mean?" The nurse replies:

Question

a. "It's complicated but if you like I'll have the payments office discuss it with you.".
b. "You pay a sliding fee for each illness based on your monthly take-home income.".
c. "You pay a fixed fee per month while the HMO provides all medically necessary care.".
d. "The HMO pays your physician a flat fee for a particular episode of illness regardless of the number of office visits you make.".

Answer 1

C
Capitation calls for the consumer to pay a fixed fee or a per-member-per-month premium. In return, the managed care company agrees to provide all medically necessary health care for all covered people.