Capitation funding of primary health organisations in New Zealand: are enrolled populations being funded according to need?
OBJECTIVE
To determine whether the three main funding formulas for Primary Health Organisations achieved a stated aim of the Primary Health Care Strategy to fund enrolled populations according to need.


METHODS
National data were obtained from the Ministry of Health for a 12-month period beginning in April 2004: these included demographic characteristics of the enrolled Primary Health Organisation population, plus rates tables for: First-Contact Services, Services to Improve Access, and Health Promotion. Funding for Access and Interim practices for four-quarters was calculated for each of these three funding streams. Analysis of the demographic characteristics of Access and Interim practices was undertaken.


RESULTS
Maori and Pacific peoples made up a greater proportion of the Access population than the Interim, had higher rates of deprivation than the non-Maori/non-Pacific population, and demonstrated a younger age distribution. The first quarter (April 2004-June 2004) showed there was preferential funding for Access PHOs and in particular high-needs groups. In quarter two, this level of preferential funding had diminished, coinciding with the introduction of increased government funding for all Interim enrolees aged 65 and over.


CONCLUSIONS
The greater funding for Access enrolees was notably eroded with the introduction of Access-level funding for those aged 65+ in Interim PHOs. Since these data were analysed all remaining Interim age groups have shifted to Access-level funding, benefiting non-Maori /non-Pacific in Interim PHOs. The rapid shift to Access-level funding for First Contact Services has seen a continued erosion of the redistributive effect of the original needs-based formulas. A system cannot be considered equitable if some members of society are not realising their health potential, and financing of primary care should remain redistributive until such a time as this objective is attained.
Langton
Jennifer
J
Pharmacy Department, Capital and Coast District Health Board, Wellington, New Zealand.
Crampton
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002204:Capitation Fee / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006303:Health Services, Indigenous / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data