On this page
- About capitation rates
- 1. First level health services by access practices for enrolled persons
- 2. First level health services by non-access practices for enrolled persons
- 3. Health promotion services
- 4. Services to improve access for high need groups
- 5. Care Plus services
- 6. Fees for administering vaccine episodes
- 7. Rural workforce retention
- 8. Management services
- 9. Very Low Cost Access – Practice component
- 10. Zero Fees for Under-6s
- 11. Zero Fees for Under-14s
- 12. Community Services Card Funding Rates (non-VLCA CSC holders)
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 2023. 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 |
$493.6236 |
$737.8764 |
|
M |
$519.7164 |
$737.8764 |
05–14 |
F |
$156.2472 |
$473.1072 |
|
M |
$146.2500 |
$473.1072 |
15–24 |
F |
$144.1764 |
$455.7468 |
|
M |
$79.3500 |
$455.7468 |
25–44 |
F |
$126.6964 |
$455.7468 |
|
M |
$81.8964 |
$455.7468 |
45–64 |
F |
$173.5296 |
$499.1520 |
|
M |
$129.6072 |
$499.1520 |
65+ |
F |
$299.0448 |
$535.3236 |
|
M |
$257.8920 |
$535.3236 |
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 |
$481.7232 |
$737.8764 |
|
M |
$512.6208 |
$737.8764 |
05–14 |
F |
$124.0248 |
$473.1072 |
|
M |
$117.5424 |
$473.1072 |
15–24 |
F |
$144.1764 |
$455.7468 |
|
M |
$79.3500 |
$455.7468 |
25–44 |
F |
$126.6948 |
$455.7468 |
|
M |
$81.8964 |
$455.7468 |
45–64 |
F |
$173.5296 |
$499.1520 |
|
M |
$129.6072 |
$499.1520 |
65+ |
F |
$299.0448 |
$535.3236 |
|
M |
$257.8920 |
$535.3236 |
3. Health promotion services
Health Promotion | Non High Use Health Card Holders | |
---|---|---|
Māori/Pacific | Non Māori/Non Pacific | |
Deprivation deciles 1–8 | $3.0828 | $2.5692 |
Deprivation deciles 9–10 | $3.5976 | $3.0828 |
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 |
$88.8096 |
$177.6204 |
$0.00 |
$88.8096 |
M |
$93.5028 |
$187.0116 |
$0.00 |
$93.5028 |
|
05–14 |
F |
$28.1112 |
$56.2224 |
$0.00 |
$28.1112 |
M |
$26.3124 |
$52.6260 |
$0.00 |
$26.3124 |
|
15–24 |
F |
$25.9380 |
$51.8784 |
$0.00 |
$25.9380 |
M |
$14.2764 |
$28.5540 |
$0.00 |
$14.2764 |
|
25–44 |
F |
$22.7940 |
$45.5892 |
$0.00 |
$22.7940 |
M |
$14.7336 |
$29.4696 |
$0.00 |
$14.7336 |
|
45–64 |
F |
$31.2192 |
$62.4420 |
$0.00 |
$31.2192 |
M |
$23.3184 |
$46.6368 |
$0.00 |
$23.3184 |
|
65+ |
F |
$53.8032 |
$107.6064 |
$0.00 |
$53.8032 |
M |
$46.3992 |
$92.7972 |
$0.00 |
$46.3992 |
5. Care Plus services
$289.1796
6. Fees for administering vaccine episodes
Childhood immunisation | $36.05 |
Influenza immunisation | $36.05 |
Administration of the zoster (shingles) vaccine and the influenza vaccine on the same occasion | $20.52 |
7. Rural workforce retention
Rural ranking score | Rate per capita |
35–40 | $8.51 |
45-50 | $12.78 |
55–65 | $17.03 |
70+ | $21.27 |
8. Management services
- 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 $18.3348 per person up to 20,000 and $1.0572 per person from 20,001 to 40,000.
- Otherwise, if the number of Enrolled Persons in the PHO is between 40,001 and 75,000, the rate will be $13.0464 per person up to 20,000 and $6.3444 per person from 20,001 to 75,000.
- If the number of Enrolled Persons in the PHO is 75,001 or above, then the rate will be $609,870 plus $7.1244 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 | $108.5808 |
M | $114.3204 | |
5-14 | F | $84.1572 |
M | $83.9592 | |
15–24 | F | $78.2160 |
M | $47.5404 | |
25-44 | F | $108.8112 |
M | $119.8428 | |
45–64 | F | $216.6876 |
M | $222.5448 | |
65+ | F | $286.0752 |
M | $305.7432 |
9.2 Very Low Cost Access – Non Community Services Card
Age Group | Gender | Rates per capita |
0–4 | F | $108.5808 |
M | $114.3204 | |
5–14 | F | $78.6780 |
M | $78.4596 | |
15–24 | F | $43.2168 |
M | $23.7864 | |
25–44 | F | $37.9752 |
M | $24.5496 | |
45–64 | F | $52.0152 |
M | $38.8500 | |
65+ | F | $89.6376 |
M | $77.3040 |
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 | $108.5808 |
M | $114.3204 | |
05-14 | F | $3.3960 |
M | $3.1788 |
11. Zero Fees for Under-14s
Age bands | Gender | Annual rate |
00–04 | F | $108.5808 |
M | $114.3204 | |
05–14 | F | $78.6780 |
M | $78.4596 |
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 | $5.4792 |
M | $5.4996 | |
15–24 | F | $78.2160 |
M | $47.5404 | |
25–44 | F | $108.8112 |
M | $119.8428 | |
45–64 | F | $216.6876 |
M | $222.5448 | |
65+ | F | $286.0752 |
M | $305.7432 |