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)
- 13. Contingent Capitation Rates
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 2025. 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.
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 | $546.5244 | $737.8764 |
M | $581.5788 | $737.8764 | |
05–14 | F | $156.2472 | $473.1072 |
M | $146.2500 | $473.1072 | |
15–24 | F | $163.5708 | $455.7468 |
M | $90.0240 | $455.7468 | |
25–44 | F | $143.7384 | $455.7468 |
M | $92.9136 | $455.7468 | |
45–64 | F | $196.8732 | $499.1520 |
M | $147.0420 | $499.1520 | |
65+ | F | $339.2724 | $535.3236 |
M | $292.5840 | $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 | $546.5244 | $737.8764 |
M | $581.5788 | $737.8764 | |
05–14 | F | $140.7084 | $473.1072 |
M | $133.3536 | $473.1072 | |
15–24 | F | $163.5708 | $455.7468 |
M | $90.0240 | $455.7468 | |
25–44 | F | $143.7384 | $455.7468 |
M | $92.9136 | $455.7468 | |
45–64 | F | $196.8732 | $499.1520 |
M | $147.0420 | $499.1520 | |
65+ | F | $339.2724 | $535.3236 |
M | $292.5840 | $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 | $46.05 |
Influenza/COVID immunisation | $37.50 |
Administration of more than one vaccine on the same occasion | $20.52 |
7. Rural workforce retention
Rural ranking score | Rate per capita |
35–40 | $9.42 |
45-50 | $14.14 |
55–65 | $18.85 |
70+ | $23.54 |
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 | $127.9752 |
M | $134.7396 | |
5-14 | F | $99.5052 |
M | $99.2724 | |
15–24 | F | $95.1024 |
M | $57.8040 | |
25-44 | F | $132.3036 |
M | $145.7160 | |
45–64 | F | $263.4684 |
M | $270.5916 | |
65+ | F | $347.8368 |
M | $371.7516 |
9.2 Very Low Cost Access – Non Community Services Card
Age Group | Gender | Rates per capita |
0–4 | F | $127.9752 |
M | $134.7396 | |
5–14 | F | $93.0264 |
M | $92.7696 | |
15–24 | F | $52.5468 |
M | $28.9224 | |
25–44 | F | $46.1736 |
M | $29.8500 | |
45–64 | F | $63.2448 |
M | $47.2380 | |
65+ | F | $108.9900 |
M | $93.9936 |
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 (CSC holder) | 18 and above (non-CSC holder) |
$0.00 | $13.50 | $20.00 | $30.50 |
10. Zero Fees for Under-6s
Age bands | Gender | Annual rate |
0-04 | F | $127.9752 |
M | $134.7396 | |
05-14 | F | $4.0152 |
M | $3.7584 |
11. Zero Fees for Under-14s
Age bands | Gender | Annual rate |
00–04 | F | $127.9752 |
M | $134.7396 | |
05–14 | F | $93.0264 |
M | $92.7696 |
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 | $6.4788 |
M | $6.5028 | |
15–24 | F | $95.1024 |
M | $57.8040 | |
25–44 | F | $132.3036 |
M | $145.7160 | |
45–64 | F | $263.4684 |
M | $270.5916 | |
65+ | F | $347.8368 |
M | $371.7516 |
13. Contingent Capitation Rates
Age Bands | Gender | Annual rate |
00-04 | Female | $32.7612 |
Male | $34.8624 | |
5-14 | Female | $8.5020 |
Male | $8.0544 | |
15-24 | Female | $9.8100 |
Male | $5.3964 | |
25-44 | Female | $8.6256 |
Male | $5.5728 | |
45-64 | Female | $11.8224 |
Male | $8.8272 | |
65 + | Female | $20.4132 |
Male | $17.6052 |