A plan may assign you to doctors, specialists, etc. and pay those health providers a flat rate in advance based on the number of patients assigned, not on how much care they need.

For instance, your primary care doctor may get $10 a month for you, whether you come every week or never show at all; all of your doctor's patients may be assigned to a single x-ray group that receives 15 cents a month whether anyone gets an x-ray or not.

It discourages doctors from doing extra things to you just to make money. On the other hand, it means you do not have the choice of seeing anyone other than the capitated provider. Also, if the doctor's average HMO patient requires more care than the average capitation covers, the doctor could get in financial trouble, which might leave you in the lurch just when you are sick.




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©2000 Eileen K. Carpenter, MD