What capitation is and why it inverts the sales argument

Capitation flips the sign on nearly everything. The income is already in and fixed; every visit that happens consumes it. The finance director reads the same dashboard as a counterpart at a fee-for-service clinic and takes the opposite meaning from it.

Chile's best-known example is the per capita state contribution to municipal primary care. Article 49 of Ley 19.378 sets it by annual decree according to the beneficiary population of the district, its socioeconomic level and rurality, and the services actually delivered. US Medicaid managed care rules state the mechanism plainly: a capitation payment is made for each enrolled beneficiary whether or not that person receives any service during the period it covers.

Why can a full appointment book be bad news?

Because volume and value come apart. A system that opens slots and fills them raises this period's spend while saying nothing about the clinical result. Under capitation the question that matters is which orders avoid a larger cost later, and that list is shorter than the full list of open orders.

It gets confused with fee-for-service, and plenty of providers live with both at once depending on the contract. The capitated case is defended with the methodology in how we measure: what spend was avoided, measured against a comparable group, over the same window.