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

  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 $18.3348 per person up to 20,000 and $1.0572 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 $13.0464 per person up to 20,000 and $6.3444 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 $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