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Payment Methodologies

Five Payment Models

Choose the model that aligns with your facility type, payer mix, and operational capacity. Synora supports all five methodologies through its digital platform.

Model 01

Fee-for-Service

The most widely used model in Ethiopia. Providers are reimbursed a fixed fee for each service rendered, based on the negotiated Synora fee schedule aligned with EHIS tariffs.

Simple, transparent billing with no population risk
305 procedure codes covered in Synora's standard fee schedule
Quarterly tariff reviews and geographic adjustments
+12% quality bonus for Platinum-tier providers
Best for: Clinics & Hospitals All facility types
How It Works
01
02
03
Service
Invoice
Payment
OPD ConsultationETB 450
CBC Lab PanelETB 320
Chest X-RayETB 580
Total ClaimETB 1,350
Monthly Capitation Flow
500
Assigned members
From Ethio Telecom plan
ETB 200/mo
×
Monthly Capitation Payment =
ETB 100,000
Members who visited this month180 (36%)
Cost per actual visitETB 556
Unused capitation (surplus)+ETB 0 (paid regardless)
Model 02

Capitation

Providers receive a fixed monthly per-member payment for a defined population, regardless of how many members visit. Encourages preventive care and efficient service delivery.

Predictable monthly revenue regardless of visit volume
Incentivizes wellness and preventive care over volume
Monthly payment by 5th business day, no claims required
Reinsurance available for high-cost cases above ETB 50K
Best for: Primary care clinics Community facilities
Model 03

Bundled Payment

A single fixed payment covers all services related to a defined episode of care — e.g., a normal delivery, appendectomy, or cataract surgery — regardless of what it actually costs to deliver.

Example: Normal Delivery Bundle
Antenatal visits (4×)ETB 2,400
Delivery + theaterETB 6,000
Postpartum care (2 days)ETB 1,800
Bundle PriceETB 9,500
HospitalsMaternity CentersSurgical Units
Model 04

Case-Based Reimbursement

Similar to DRG (Diagnosis Related Groups). Payment is based on the patient's primary diagnosis category rather than individual services. Encourages efficiency in hospital care.

Case Rate Examples
Appendectomy (uncomplicated)ETB 12,000
Pneumonia (adult, 3-day stay)ETB 8,500
Hip fracture (surgical)ETB 28,000
Cataract (day surgery)ETB 7,200
Tertiary HospitalsSpecialist Centers
Model 05 · Premium

Performance Incentives

Pay-for-Performance (P4P) bonuses layered on top of base payment models. Providers who exceed quality thresholds earn additional payments tied to measurable outcomes.

Quality Score Bonus: +8–15% on approved claims for Gold/Platinum providers
Claims Accuracy Bonus: +ETB 50 per error-free claim for providers above 98% accuracy
Patient Satisfaction Bonus: Quarterly ETB 20,000 award for top-rated facilities
Prevention Bonus: Incentive for measurable reduction in preventable hospital readmissions
Performance Bonus Tracker
Quality Score Bonus (Q1 2025)+ETB 31,200
Quality score: 91/100 · Gold tier (+8%)
Claims Accuracy Bonus+ETB 15,600
94% accuracy · 312 error-free claims × ETB 50
Total Bonus Earned — Q1ETB 46,800
Paid 12 May 2025 · Eligible for Platinum upgrade Q2
Model Comparison

Which Model Is Right for You?

Model Best Suited For Revenue Predictability Admin Complexity Quality Incentive
Fee-for-Service All facility types, new entrants
⬤⬤⬤◯◯
Medium
⬤◯◯◯◯
Low
+8–15% bonus available
Capitation Primary care, community health
⬤⬤⬤⬤⬤
Very High
⬤⬤◯◯◯
Medium
Prevention bonus available
Bundled Payment Hospitals, maternity, surgery
⬤⬤⬤⬤◯
High
⬤⬤⬤◯◯
Medium
Efficiency gains = profit
Case-Based Tertiary, specialist hospitals
⬤⬤⬤◯◯
Medium
⬤⬤⬤◯◯
Medium
Length-of-stay efficiency
P4P Bonus Layer All models — Gold+ providers
⬤⬤⬤⬤⬤
Adds to base
⬤◯◯◯◯
Automatic
Core purpose of this model