title: Converting to a capitation system for dialysis payment--the Portuguese experience.
abstract: Due to the challenge of operating within an economically strained healthcare budget, Portuguese health authorities convened with dialysis providers and agreed on a framework to change from a fee-for-service reimbursement modality to a capitation payment system for hemodialysis. This article reviews the components of the agreed capitation package implemented in 2008 as well as the necessary preparatory work undertaken by a for-profit 34-unit dialysis network (approx. 4,200 patients) to cope with the introduction of this system. Furthermore, trends in clinical quality indicators and in resource management are reviewed for 3 years immediately following capitation introduction. Here, improvements were observed over time for the specified clinical targets. Simultaneously, costs controllable by the physician could be reduced. As more countries convert to a capitation or bundled payment system for hemodialysis services, this article offers insight into the scope of the necessary preparatory work and the possible consequences in terms of costs and treatment quality.
authors.affiliation: Fresenius Medical Care, Lisbon, Portugal. pedro.ponce@fmc-ag.com
authors.forename: Pedro
authors.initials: P
authors.lastname: Ponce
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.forename: António
authors.initials: A
authors.lastname: Guerreiro
authors.forename: Aileen
authors.initials: A
authors.lastname: Grassmann
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonçalves
authors.forename: Laura
authors.initials: L
authors.lastname: Scatizzi
authors.forename: Inga
authors.initials: I
authors.lastname: Bayh
authors.forename: Andrea
authors.initials: A
authors.lastname: Stopper
authors.forename: Ricardo
authors.initials: R
authors.lastname: Da Silva
mesh_terms: D002204:Capitation Fee; D003695:Delivery of Health Care / Q000191:economics*; D018588:Fee-for-Service Plans; D006801:Humans; D011174:Portugal; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000191:economics*