An Evaluation of Three Payment Strategies for Capitation for Medicare
评估三种不同机构（医保承运商、医生守门人、医生服务提供者）接收按人头付费的策略，分析每种策略向医疗服务提供者转移的风险。
Capitation payment for health care costs is one type of incentive-based or prospective payment system. Under capitation, payments are made for all medical services delivered in a fixed period of time (e.g., one year). In contrast, the DRG system provides for payment made for all services required during a hospital visit. Like the DRG system, capitation payment places the provider at risk because the payment amount will be the same irrespective of the resources needed to treat that person for the predetermined interval. This risk creates incentives for the individual or organization that receives the capitation rates to control the use of services in order to earn a profit. An important dimension in developing a capitation system is the selection of the appropriate institutional entity to receive payment (and hence to manage risk) and the relationship of that entity to those who directly provide services. Three capitation strategies with different entities (Medicare carrier or intermediary, physician gatekeeper, physician service provider) receiving the capitation payment are identified. The three capitation strategies are then evaluated in terms of the risk transferred to providers by each strategy.