GP capitation payments: the New Zealand experience
There has been no discernable increase in preventive care services by GPs paid an annual fee to look after the health of their patients, according to the New Zealand Medical Association.
As Federal Health Minister Peter Dutton mulls the merits of introducing so-called capitation payments for GPs – under which they would be paid an annual fee for each patient on their books – NZMA Chief Executive Lesley Clarke said the introduction of such a system in her country more than a decade ago had improved access to primary care.
But Ms Clarke, who visited Australia earlier this month, told Australian Medicine there was as yet no evidence the change had driven an increase in preventive health activity, such as more regular health checks or increased monitoring of diet, exercise and other lifestyle factors.
Under arrangements introduced in New Zealand in 2002, GPs derive half their income from capitation payments, with the remainder fee-for-service payments which, under the Kiwi system, include hefty patient co-payments of around $45 to $50 per visit ($17 for disadvantaged groups).
Ms Clarke said most of her members appeared comfortable with the split in sources of income: “Overall, it has been a positive thing for GPs in terms of certainty of revenue and flexibility of funding.”
Mr Dutton has indicated he is looking favourably upon what he calls New Zealand’s “blended” approach.
“I think there is an opportunity for us to perhaps look at doctors and other stakeholders in the conversation about blended payments,” the Minister told a General Practice Registrars conference last month. “There are international examples. New Zealand is perhaps the closest relevant example to us about the way in which they provide support to their GP network, which is a system of blended payments, probably skewed more towards capitation has flatlined since the introduction of capitation – it has not gone up,” Ms Clarke said. “But if you look at the Maori, who make up 15 per cent of the population, their avoidable admissions have gone up.”
Published: 15 Apr 2014