The Government’s policy direction is to encourage a multi-disciplinary approach to improving access to health care through the establishment of district alliances to coordinate the provision of health services between secondary, primary and community-based health services.
Services to Improve Access (SIA) funding is available for all PHOs to reduce inequalities among those populations that are known to have the worst health status:
- Pacific people
- those living in NZDep index 9–10 decile areas.
The funding is for new services or improved access for high needs patients and is additional to the main PHO capitation funding for general practice-type care. Funds are allocated according to the number of people from these population groups enrolled in the PHO.
The need for high quality primary health services, that are culturally competent, is identified by tangata whenua and Pacific peoples as very important.
Standard conditions for SIA funding
To be approved for funding, the PHO will provide Te Whatu Ora with proposals for services and activities that:
- are targeted to high needs persons in its enrolled population identified as Māori/tangata whenua, Pacific peoples and/or people living in NZDep index 9–10 decile areas
- show that the service or activity is directed at improving the health of these target groups and improving their access to primary health care services
- provide a clear description of the service to be delivered and steps for implementation including:
- name of the provider/s who will provide the services
- a timeframe for commencement of service delivery
- a budget appropriate to service delivery and management
SIA funding can be used to extend or continue existing services, however the PHO must demonstrate the actual use of SIA funding to ensure that the service is not funded twice.
Very Low Cost Access scheme
The Very Low Cost Access (VLCA) scheme supports general practices with an enrolled population of 50% or more high needs patients where the practice agrees to maintain patient fees at a low level.
The VLCA scheme was introduced in October 2006. This is a voluntary scheme that general practices can opt out of at any time if they find it is no longer appropriate for them.
Patients wanting to know if the practice they attend is part of the VLCA scheme should ask their doctor or practice nurse.
Very Low Cost Access payments
VLCA payments provide:
- extra funding in return for PHOs and general practices agreeing to maintain fees within the fees thresholds
- recognition of the extra effort involved in providing services to high need populations, and keeping fees low for the people who can least afford primary health care and improving health outcomes for those most likely to have the worst health.
Eligibility criteria for the Very Low Cost Access payment
From October 2009, eligibility for the Very Low Cost Access payment is limited to PHOs and contracted general practices meeting the eligibility criteria of 50% high needs population (defined as Māori, Pacific or New Zealand Deprivation Index quintile 5), and currently charging or prepared to reduce their fees to:
- zero fees for children aged 0–13 years.
- $13 maximum for children aged 14–17 years.
- $19.50 maximum for adults aged 18 years and over.
The PHO must also have entered into the most current version of the PHO Services Agreement (where a variation to that Agreement has been made during a payment quarter, the PHO must have entered into the most current version of that Agreement.