Skip to main content

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
Back to article page

Australia and New Zealand Health Policy

ISSN: 1743-8462