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Capitation Based Funding

Overview

Karo has over a decade of knowledge and experience in working with PHOs. We are keen to share that accumulated expertise with our clients. If the answer to your question is not here then feel free to contact us for more information.

The PHO register, on which funding is based, is now held by the Ministry of Health in their NHI (National Health Index) and NES (National Enrolment Service) data sets.

The NHI data set can, with the exception of the NHI number and DOB, be updated by the MoH, practices, DHBs and other authorised agencies. This data set holds the core information about the patient: names, gender, ethnicity, address and address associated information. 

The NES data set can be updated by the MoH and by practices directly. This data set holds the core information about the patient's enrolment with a practice/PHO: enrolment date, enrolling organisation, expiry date, date of last qualifying encounter, CSC and HUHC status, facility and optionally the provider they are enrolled with.

Each practice management system has its own implementation that manages how the practice is able to interface with the two data sets.

It is critical that practices update both the NHI and NES data sets in an accurate and timely fashion as this will directly impact the funding of the practice and the PHO.

We have summarised key aspects relating to the enrolment processes, the funding formula and how data is captured and processed for use by PHOs and practices. Refer to the menu on the left (or above) to view the topics we have covered.