Primary Health Care

Very Low Cost Access Payments

Very low cost access payment effective from 1 October 2006

A very low cost access payment for Primary Health Organisations (PHOs) and their practices that meet and maintain very low fees was introduced on 1 October 2006.

Those PHO practices that charge very low fees typically serve high need communities. The very low cost access payment is a way to support PHOs and their practices that, in order to deliver on very low cost access to primary health care and reduce health inequalities, have forgone revenue from patient fees.

Why support very low cost access?

This initiative is designed to:

provide extra support to PHO practices that charge very low fees
recognise that the eligible practices typically serve communities with high health needs who do not have the income to support higher fees
provide extra funding in return for PHOs and individual PHO practices agreeing to maintain fees within the fees thresholds. Participation in this initiative is voluntary
recognise the extra effort involved in providing services to concentrated high need populations (which are typical of practices charging very low fees) and making the aims of the Primary Health Care Strategy real for those communities
keep fees very low for people who can least afford primary health care and improve health outcomes for those likely to have the worst health.

Eligibility criteria for the very low cost access payment

Eligibility for the very low cost access payment will be limited to PHOs/practices currently charging or prepared to reduce their fees for standard consultations to the thresholds specified below:

zero fees for children 0 - 5 years
$10.50 maximum for children 6 -17 years and
$16.00 maximum for all adults 18 years and over.

The PHO must meet two pre-requisites:

it must be participating in the PHO Performance Programme
it must have entered into the most current version of the PHO Agreement (where a variation to that Agreement has been made during a payment quarter, the PHO must have entered into the most current version of that Agreement by a date determined by the DHB).

The value of the very low cost access payment

The very low cost access payment will comprise an individual practice component and a “whole of PHO” component.

The individual practice component will comprise a 20 percent increase on First Contact capitation at non High Use Health Card rates only for each PHO practice that meets the very low fee thresholds. This is equivalent to an extra $5.67 per notional visit for all enrolees 6 years and over and an extra $7.94 for children under 6 years at 2007/08 rates. This is the major portion of the very low cost access payment and PHOs will flow it through to the eligible practices.

The whole of PHO component will comprise a 20 percent increase on Services to Improve Access funding for PHOs where all their practices meet the very low fee thresholds. PHOs will have flexible use of this portion of the very low cost access payment so long as its use is related to implementing the primary health care strategy including reducing health inequalities, and subject to DHB approval for transparency and accountability purposes.

View details of the very low cost payment (at rates that apply from 1 October 2007).

Adjusting the fee benchmark over time

As the very low cost access payment is calculated as a percentage of the First Contact and Services to Improve Access funding, the value of the very low cost access payment is adjusted annually in line with the adjusted base. The very low fees threshold (that is, the maximum fees that can be charged to be eligible) is also adjusted annually to maintain value by the same percentage as the capitation base adjustment.

Read more about Very Low Cost Access funding.

Page last updated: 8 July 2008