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About capitation rates

Capitation-based payments are based on the numbers of the enrolled with individual general practices who belong to a primary health organisation (PHO) population.

 

This means that PHOs and their general practices are paid according to the number of people enrolled, not the number of times a general practice sees patients.

 

Capitation rates from 1 July 2022. All rates exclude GST and are annualised amounts.

 

This system is general called capitation since it is based on a payment per capita (per head).

 

In general, people need more care when they are very young and as they get older.

 

Women in their child-bearing years tend to need services more frequently than men.

 

The formula for calculating capitation payments takes into account the demographic make-up of the population.

 

The capitation-based payment system does not differentiate between a doctor or a nurse visit as in some cases health services may be more appropriate to be provided by a nurse rather than a doctor.

 

For definitions of the terms used on this page, see the CentralTAS website.

1. First level health services by access practices for enrolled persons

Access First Contact

High Use Health Card

Age Group

Gender

N

Y

00–04

F

$470.1180

$702.7392

 

M

$494.9676

$702.7392

05–14

F

$148.8072

$450.5784

 

M

$139.2852

$450.5784

15–24

F

$137.3112

$434.0448

 

M

$75.5712

$434.0448

25–44

F

$120.6612

$434.0448

 

M

$77.9964

$434.0448

45–64

F

$165.2664

$475.3824

 

M

$123.4356

$475.3824

65+

F

$284.8044

$509.8320

 

M

$245.6112

$509.8320

2. First level health services by non-access practices for enrolled persons

Access First Contact

High Use Health Card

Age Group

Gender

N

Y

00–04

F

$458.7840

$702.7392

 

M

$488.2104

$702.7392

05–14

F

$118.1184

$450.5784

 

M

$111.9456

$450.5784

15–24

F

$137.3112

$434.0448

 

M

$75.5712

$434.0448

25–44

F

$120.6612

$434.0448

 

M

$77.9964

$434.0448

45–64

F

$165.2664

$475.3824

 

M

$123.4356

$475.3824

65+

F

$284.8044

$509.8320

 

M

$245.6112

$509.8320

3. Health promotion services

Health Promotion Non High Use Health Card Holders
Māori/Pacific Non Māori/Non Pacific
Deprivation deciles 1–8 $2.9364 $2.4468
Deprivation deciles 9–10 $3.4260 $2.9364

4. Services to improve access for high need groups

Services to Improve Access Non High Use Health Card Holders
Māori/Pacific Non Māori/Non Pacific
Age Group Gender Deprivation deciles 1–8 Deprivation deciles 9–10 Deprivation deciles 1–8 Deprivation deciles 9–10
00–04 F $84.5808 $169.1628 $0.00 $84.5808
M $89.0508 $178.1064 $0.00 $89.0508
05–14 F $26.7720 $53.5452 $0.00 $26.7720
M $25.0596 $50.1204 $0.00 $25.0596
15–24 F $24.7032 $49.4076 $0.00 $24.7032
M $13.5960 $27.1944 $0.00 $13.5960
25–44 F $21.7080 $43.4184 $0.00 $21.7080
M $14.0316 $28.0668 $0.00 $14.0316
45–64 F $29.7324 $59.4684 $0.00 $29.7324
M $22.2084 $44.4156 $0.00 $22.2084
65+ F $51.2412 $102.4824 $0.00 $51.2412
M $44.1900 $88.3788 $0.00 $44.1900

5. Care Plus services

$275.4096

6. Fees for administering vaccine episodes

Childhood immunisation $27.84
Influenza immunisation $27.84
Administration of the zoster (shingles) vaccine and the influenza vaccine on the same occasion $19.54

7. Rural workforce retention

Rural ranking score Rate per capita
35–40 $8.10
45-50 $12.17
55–65 $16.22
70+ $20.26

8. Management services

  1. If the number of Enrolled Persons in the PHO is 40,000 or below and the DHB has approved the PHOs’ Management Services Plan, then the rate will be $17.4612 per person up to 20,000 and $1.0068 per person from 20,001 to 40,000.
  2. Otherwise, if the number of Enrolled Persons in the PHO is between 40,001 and 75,000, the rate will be $12.4248 per person up to 20,000 and $6.0420 per person from 20,001 to 75,000.
  3. If the number of Enrolled Persons in the PHO is 75,001 or above, then the rate will be $580,806 plus $6.7848 per person over 75,000 enrolees.

9. Very Low Cost Access – Practice component

9.1 Very Low Cost Access – Community Services Card

Age Group Gender Rates per capita
0–4 F $103.4100
  M $108.8760
5-14 F $79.8540
  M $79.6668
15–24 F $71.8356
  M $43.6620
25-44 F $99.9348
  M $110.0664
45–64 F $199.0116
  M $204.3912
65+ F $262.7388
  M $280.8024

9.2 Very Low Cost Access – Non Community Services Card

Age Group Gender Rates per capita
0–4 F $103.4100
  M $108.8760
5–14 F $74.6556
  M $74.4480
15–24 F $39.6912
  M $21.8460
25–44 F $34.8780
  M $22.5468
45–64 F $47.7720
  M $35.6808
65+ F $82.3260
  M $70.9980

9.3 Very Low Cost Access and CSC scheme – Practice fee for enrolled people for each standard consultation at or below the following amounts (GST included)

0–13 year olds 14–17 year olds 18 and above
$0.00 $13.00 $19.50

10. Zero Fees for Under-6s

Age bands Gender Annual rate
0-04 F $103.4100
  M $108.8760
05-14 F $3.2220
  M $3.0168

11. Zero Fees for Under-14s

Age bands Gender Annual rate
00–04 F $103.4100
  M $108.8760
05–14 F $74.6556
  M $74.4480

12. Community Services Card Funding Rates (non-VLCA CSC holders)

Age Bands Gender Annual rate
00–04 F $0.0000
  M $0.0000
05–14 F $5.1984
  M $5.2188
15–24 F $71.8356
  M $43.6620
25–44 F $99.9348
  M $110.0664
45–64 F $199.0116
  M $204.3912
65+ F $262.7388
  M $280.8024