With the introduction of guarantee funding, Access-funded firms were capped, and interim-sponsored practices were required to reduce their co-payments by a mandatory amount8, so that differences prior to the implementation of the strategy were maintained with respect to fees for non-access practices. The annual supplement plan is defined in the PHO9 service agreement. The agreement provides for an independent list of “reasonable rate increases,” which sets a maximum annual increase in co-payments on a percentage basis.10 Guarantee funding (a form of population-based primary procurement funding) has been used to some extent in New Zealand since the 1940s 111 and 13. , after the implementation of the primary health care strategy, which was the predominant funding mechanism for PhOs. Pho head funding formulas have been described in more detail elsewhere7,14-17 and, as noted above, changes to formulas since the first implementation of the primary health care strategy are incremental and scalable. Some of the key policy steps of the past 18 years are included in Table 1. The amendments introduced on December 1, 2018 are due to negotiations of the PHO Services Agreement Amendment (PSAAP) Protocol Group. This group negotiates the national agreement on the financing and provision of primary care services and includes PHOs, contract providers (mainly general practices), DHBs and the Ministry of Health26. The PHO must also have completed the most recent version of the PHO service agreement (if an amendment to this agreement was made during a payment quarter, the most recent version of this agreement must have been finalized by a date set by DHB and PHO). As a result of changes in the Primary Health Care Strategy, significant progress has been made in reducing barriers to access for many people, particularly children and adolescents, resulting in positive results23. In other words, important fiscal policy decisions have been made more in the context of supplier negotiations than on the basis of an open, principled, policy-based process. The impact of these funding changes must now be assessed. This assessment should be carried out in the context of broader and, in some cases, long-standing concerns about the need for further changes in primary procurement funding to address a number of issues.13,15,27,37,39,40 Examples of the types of questions to be answered are cited below.


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