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 2024. 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.

$289.1796

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.