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Secondary capitation is a relationship arranged by a managed care organization between a physician and a secondary or specialist provider, such as an X-ray facility or ancillary facility such as a durable medical equipment supplier whose secondary provider is also paid capitation based on that PCP's enrolled membership.
India is a country with one of the lowest health insurance penetration, with only 18% of people in urban areas and 14% in rural areas covered under any kind of health insurance scheme. [9] One of the main reasons for the low penetration and coverage of health insurance is the lack of competition in the sector.
Rashtriya Swasthya Bima Yojana (RSBY, literally "National Health Insurance Programme", [1]) is a government-run health insurance programme for the Indian poor. The scheme aims to provide health insurance coverage to the unrecognised sector workers belonging to the BPL category and their family members shall be beneficiaries under this scheme. [2]
According to the National Health Accounts report, the total expenditure on health care as a proportion of GDP in 2018 was 3.2%. [8] Out of 3.2%, the governmental health expenditure as a proportion of GDP is just 2%, [9] and the out-of-pocket expenditure as a proportion of the current health expenditure was 42.06% in 2019 while expenditure of the government and health insurance funds increased ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
The All India Council for Technical Education (AICTE), the regulatory body for technical education in India, has called "upon the students, parents and the general public not to pay any capitation fee or any other fee other than that mentioned in the Prospectus of the Institutions for consideration of admission". [46]
Unlike capitation, bundled payment does not penalize providers for caring for sicker patients. [ 5 ] Considering the advantages and disadvantages of fee-for-service, pay for performance , bundled payment for episodes of care, and global payment such as capitation, Mechanic and Altman concluded that "episode payments are the most immediately ...
A health insurance policy is a insurance contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization).