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Table 1 PHO Types and Annual Capitation Subsidies, 2004–5 [67]

From: Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets

Capitaiton Subsidies
   GMS/Nurse Services to Improve Access
PHO Type Interim Access All
    HUHC HUHC Maori/Pacific Non Maori/Pacific
Age Group Gender CSC N Y N Y 1 thru 4 5 1 thru 4 5
00–04 F Y $308.12 $471.96 $315.73 $471.96 $63.15 $126.29 $0.00 $63.15
   N $308.12 $471.96       
  M Y $327.88 $471.96 $332.42 $471.96 $66.48 $132.97 $0.00 $66.48
   N $327.88 $471.96       
05–14 F Y $79.33 $302.61 $99.94 $302.61 $19.99 $39.98 $0.00 $19.99
   N $79.33 $302.61       
  M Y $75.18 $302.61 $93.54 $302.61 $18.71 $37.42 $0.00 $18.71
   N $75.18 $302.61       
15–24 F Y $78.90 $291.50 $92.22 $291.50 $18.44 $36.89 $0.00 $18.44
   N $36.09 $291.50       
  M Y $42.38 $291.50 $50.75 $291.50 $10.15 $20.30 $0.00 $10.15
   N $20.79 $291.50       
25–44 F Y $72.61 $291.50 $81.04 $291.50 $16.21 $32.41 $0.00 $16.21
   N $7.32 $291.50       
  M Y $43.16 $291.50 $52.38 $291.50 $10.48 $20.95 $0.00 $10.48
   N $5.91 $291.50       
45–64 F Y $88.74 $319.27 $110.99 $319.27 $22.20 $44.40 $0.00 $22.20
   N $12.22 $319.27       
  M Y $67.96 $319.27 $82.90 $319.27 $16.58 $33.16 $0.00 $16.58
   N $9.57 $319.27       
65+ F Y $191.27 $342.40 $191.27 $342.40 $38.25 $76.51 $0.00 $38.25
   N $191.27 $342.40       
  M Y $164.95 $342.40 $164.95 $342.40 $32.99 $65.98 $0.00 $32.99
   N $164.95 $342.40       
  1. Per capita management fees are paid irrespective of Access or Interim status, and are based upon PHO size:
  2. • $9.61 per individual up to 20,000 and $4.67 per individual thereafter, for PHOs with fewer than 75,000 registered individuals
  3. • $6.41 for the first 20,000, $5.83 for individuals 20,001 to 75000, and $5.25 for all others, for PHOs with more than 75,000 registered individuals
  4. Definitions
  5. PHO Types:
  6. • Interim PHOs: more than 50% of the registered population of Maori or Pacific Island Ethnicity, or living in areas determined to be in NZ Deprivation Index deciles 9 or 10.
  7. • Access PHOs: the remainder
  8. Individual Characteristics:
  9. • HUHC: High User Health Card – individual with 12 or more GP consultations in 12 months
  10. • CSC: Community Services Card – identifies low income or beneficiary status of registered individual – irrelevant for registered patients of Access practices
  11. Capitation Subsidy Type:
  12. • GMS/Nurse: subsidy for first contact services provided by General Practitioner or practice nurse – nominally based upon an effective consultation subsidy of $36.40 for children under 6 and $26 for all other population groups eligible for low or reduced cost access, thereby presuming 13 fully subsidised visits for a HUHC young child and 8.5 for others; 6.3 partially subsidised visits per annum for a 65+ man and 7.4 for a 65+ woman (3.3 and 3.8 fully subsidised visits respectively assuming a $50 cost per visit).
  13. • Services to Improve Access: capitation to develop access initiatives for high-needs populations (paid in addition to GMS/Nurse capitation