Table 1

PHO Types and Annual Capitation Subsidies, 2004–5 [67]
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





Per capita management fees are paid irrespective of Access or Interim status, and are based upon PHO size:

• $9.61 per individual up to 20,000 and $4.67 per individual thereafter, for PHOs with fewer than 75,000 registered individuals

• $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

Definitions

PHO Types:

• 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.

• Access PHOs: the remainder

Individual Characteristics:

• HUHC: High User Health Card – individual with 12 or more GP consultations in 12 months

• CSC: Community Services Card – identifies low income or beneficiary status of registered individual – irrelevant for registered patients of Access practices

Capitation Subsidy Type:

• 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).

• Services to Improve Access: capitation to develop access initiatives for high-needs populations (paid in addition to GMS/Nurse capitation

Howell Australia and New Zealand Health Policy 2005 2:20   doi:10.1186/1743-8462-2-20