The Capitation Structure Is Not Helping The Enrollee But The Provider

What is capitation? In Fundamental Book by Taylor it says, is a fixed amount per enrollee of health plan and with Timby it says, a system with preset fee assign to the member with the aim of getting quality service. Really? If the insurer budget is 5k for instance, for the annual wellness check, mammogram, drug testing and others, then how much the facility would pay for the medical practitioners, such as Physicians, nurses, technicians and even to CNAs handling the care? I am sure that with all of these services the 5k dollars would not be enough, therefore the insurance enrollees would be paying the exist amount charge for the care service provided to the patient. However, the question above was, how might the health care facility cut down its in-hospital health care cost? For what, for the facility to profit more, or to avoid extra payments from the patient/enrollee? The capitation payment strategy is a fixed payment system that the facility can receive, regardless if the enrollees use it or not, the facilities accordingly will still get the money. And if the enrollees will use it, the health care facility will allocate the money as small or lower as possible in order to hold more money than spending the money for equipment and services. Perfect example is the use of IV tubing package. To cut the cost, the facility might be using the cheapest package but is not working properly with the patient. Or the facility might be sending the patient home even the problem is not completely resolve yet, to cut the room service fees, or might be putting the patient in a shared-ward to minimize room expenses. I am sure there are other ways that a facility would cut the cost down for them to earn more rather than providing quality care service for the enrollee, unless the patient is willing to pay the extra charge. SOURCES Taylor, et. Al. (2015). Fundamentals of Nursing 8th Ed. Wolters Kluwer Timby, B. (2017). Fundamentals Nursing Skills And Concepts 11th ed. Wolters Kluwer