It points out, in low and middle-income countries

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Last updated: December 26, 2019

It is clear and broadly demonstrated that themethod of provider payment, as Donalson and Simoens argued, may impact theprovider behavior both clinical andprofessional. These behaviors at the sametime, impact the subsequent health care that those providers deliver to theirpatients.

(Donaldson 1989;Simoens 2004).  Capitation is oneof the payment method heavily challenged and criticized especially by the direct providers – physicians (Berwick 1996). Health Care systems in different countries are focussed onachieving World Health Organization (WHO) goals by means of local policyobjectives aligned with good care delivery and financial sustainability.  Nevertheless, health attributes like high qualityand accessible healthcare, are both well defined by WHO and other Health Organizationssuch as the United States National Academy of Medicine (Institute of Medicine 2001), currentlyis not easy to distinguish clearly the real impact of capitation payment on thoseattributes, especially in quality of health care. Firstly, because as Akachipoints out, in low and middle-income countries there has been relatively absence of data and measures of quality of care that can permitcomparison and benchmark within or acrosscountries (Akachi 2017).The other reason for unclear pure capitation impact on quality and access tohealth care, is that in developedcountries mainly, where capitation payment was implemented and well establishedmany years ago, it has been complemented with other payment systems, Fee for Service (FFS) or Diagnostic RelatedGroups (DRG), transforming the method into mixed one.

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   This assignment aims to contextualize in the frameof WHO goals and country policies, the definition of quality and access. Aswell the advantages and disadvantages of capitation and the possible impact on highquality and accessible healthcare in primary care, showing some empiricalevidence.                              According to theWorld Health Organization (WHO) in their World Health Report in 2000, the goalsof the Health Care Systems are defined as1. better health, 2. fairness in financial contribution and 3. responsivenessto people expectations (Who2000). The Organisationfor Economic Co-operation and Development (OCDE), outlinethat each country should be focussed on achieving these goals, defining thehealth care services that are needed, how they will be universally available, affordable,efficient, and of good quality (OCDE 2010).

 WHO´s definitionof quality of care is “the extent to which health care services provided toindividuals and patient populations improve desired health outcomes. In orderto achieve this, health care must be safe, effective, timely, efficient,equitable and people-centered.”  WHO´s 2017 report was based on two sustainabledevelopment goals (SDG): 1. population coverage dimension (that everyone –irrespective of their living standards – should receive the health servicesthey need); and 2.

Financial protection dimension of UHC (use of healthservices should not lead to ?nancial hardship). Who 2017 report reinforces that “Both indicators must be measured together tocapture the complete picture, and in particular not to miss those who areunable to access health care at all (and therefore do not pay for it at thepoint of use), and those who receive low-quality care”. (WHO 2017). Accordingto Akachi, the research and data collection in coverage access has beenexploded seeking to accomplish millenniumdevelopment goals (MDG), however, that isnor seen in the quality of care measures.This lack of data in low and income-countries does not allow to make robustcomparisons and benchmarking amongcountries.  (Akachi 2017). WHO inthe Plan of Action 2012, stated that for achieving goals it is necessary a well-functioningdomestic health system, including health financial system (WHO 2012). Brick arguedthat “More efficient use of scarce health-care resources is required and can beinfluenced by the resource allocation and financing mechanisms (Brick 2010).

Simoensstated that as a result, the setup of reimbursement might ameliorate oraggravate existing health care inequities (Simoens 2004). Providers (healthcare organizations and professionals) areinfluenced by payment methods, and those impact the care delivering. (Hillman 1991).

Therefore, payment methods to providers should encourage quality improvement andmust give value to the outcomes in which the resources are expended (Committee, OQOHC,& Institute, OMS 2001). Capitation is anadvance payment(ex-ante) of a fixed amount that is made per person who will have the right tobe served during a period, from a pre-established group of services. The unitof payment is constituted by a previously agreed rate, based on the number ofpeople who would be entitled to be served.

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