The way health care is paid for in the UK may be changing. With a nod to the ‘Managing Financial Resources’ module of our Health and Social Care Management HND, today we look at what capitated payment is and why it might be the future.

Currently, NHS healthcare commissioners pay different providers to deliver health and social care services to individual patients. Capitated payment is a system through which commissioners would pay one provider, or a linked network of providers, to cover a specific group of people. For capitated payment, the budget is calculated as a lump sum per patient. Previously, commissioners were charged after a service (like a GP appointment) had been used.

For healthcare providers, the focus is shifted from charging per usage of health care services to streamlining the patient’s care and preventing illness. With capitated payment, fewer patients mean saving the pre-agreed budget (which can be reinvested).

Will health care services become more patient-focused with capitated payment?

Often single patients need care from several services at one time if, for example, they have more than one health problem. Paying per usage can deliver a great single service; however, paying on a capitated basis encourages providers to streamline the who medical journey. Each department would then benefit from savings on the budget. Capitated payment would save commissioners money if they prevent further medical issues; this should encourage health care providers to look at long-term solutions for healthcare issues.

The lead care provider becomes responsible for making sure patients’ care is joined across the network of service providers. It becomes in the collective interest of the provider or network to make sure the patient is seen by the right health professional and is given the treatment they need promptly.

If the system works, service provider’s focus should move from seeing more patients, to preventing healthcare problems and saving money. The government also references a bonus system for providers who improve patients’ outcomes; this can be reinvested into the systems, allowing for potential long-term savings through further preventative measures. Reinvesting the savings made on the pre-agreed budget would also allow commissioners to concentrate on areas that need extra support.

The capitated payment model is currently being tested within NHS systems, with results being shared across providers. If successful, we can expect to see big changes in how health care is funded in the UK.



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