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Capitation Rates

Latest capitation rates

The MoH of Health updates the capitation rates annually; the process of assessing the level of increase normally starts in April with draft rates available in June.  The increases are not always uniform across the various types of payments.

The latest capitation rates are available on the MoH website

Karo has historical capitation rates should you require them.

What is included in capitation based funding? 

Capitation based funding is a population based funding formula. So each part of the funding formula is calculated based on the demographics of the enrolled population of the PHO/practice it has the following components:

  • First Contact Care (first level health services) - this is based on the age, gender and HUHC status of patients. It was established to cover a portion of the GP and Nurse consultation costs for patients who are enrolled with the PHO. There are currently two funding tables with the majority of practices being paid under the "Non-Access" table.  This payment is made to the practice.
  • Health Promotion Services - this is based on a flat rate for all patients and a small additional amount for Maori/Pacifica and/or Quintile 5 patients. This was established to give PHOs some funding for health promotion but has now been consolidated into the Flexible Funding Pool.
  • Services to Improve Access (SIA) - this is a payment that is made based on the needs assessment of the population there is one payment for Maori/Pacifica patients and another payment for Quintile 5 patients. This was established to give PHOs some funding for improving access to primary care services but has now been consolidated into the Flexible Funding Pool.
  • CarePlus service - this payment is based on a formula that weights the population by age, gender, quintile and ethnicity and returns a number of eligible careplus patients. The number of HUHC patients is then deducted from the eligible patients and the remainder is multiplied by the CarePlus amount. This was established to give PHOs some funding for improving access for high health need patients but has now been consolidated into the Flexible Funding Pool.
  • Very Low Cost Access (VLCA) payments is a scheme that is open to practices with more than 50% high needs patients (defined as Maori or Pacifica or Quintile 5). The payment is a fees subsidy and is paid in exchange for keeping patient co-payments at or below a fixed level. This payment is made to the practice.
  • Community Service Card rates is a scheme that is open to all non VLCA practices. The payment is a fees subsidy and is paid in exchange for keeping patient co-payments for Community Service Card Holders at or below a fixed level. This payment is made to the practice.
  • Zero Fees for Under 6 or Under 14 is a scheme that is open to all non VLCA practices. The payment is a fees subsidy and is paid in exchange for keeping patient co-payments for children under 6 or 14 at 0. This payment is made to the practice.
  • Management Services is based on the total number of patients in the register it is paid to PHOs to enable then to perform PHO Management Services.

Capitation based funding does not include funding for:

  • Maternity services - this is outside the agreement and is paid for on a "fee for service basis"
  • Immunisations services, although the rates that will be paid are specified with the funding document the payment itself is on a "fee for service basis"
  • ACC services