Nearly all OECD countries that use capitation adjust for risk factors (including age, gender and health status) to ensure that the health care needs of specific groups (such as the elderly) are properly addressed. Capitation is usually combined with fee-for-service, to encourage particular activities. Costa Rica starts from a good base here, since it already has a blended payment system in primary care, and a rich understanding of local health and social care contexts through the family record held within EDUS. Ideally, payments to clinicians should reflect value, as far as possible.