Although the official campaign is yet to start, it seems everybody is already in campaign mode, and it is not pretty.
Will we ever be able to have mature public discourse on issues involving Māori?
Last week’s braying from politicians and radio performers after the supposed scoop over the elective surgery waiting list algorithm had me stomping around the house expostulating for days.
The idea that applying the algorithm in Auckland hospitals meant Māori and Pasifika people were leapfrogging up the elective surgery waiting lists (despite their dodgy hips) ahead of equally deserving Pakeha sent some into a frenzy. (Ironically, the reverse has been happening for years without an algorithm or any public outrage).
The only trouble was that was not exactly what was going on.
But it is election year, so it is convenient for politicians to ignore the detail and seize the sensational simplistic soundbite, ramping up fears about racial favouritism. Initial radio reporting on this was so inflammatory and lacking nuance it made that inevitable.
The algorithm was not applied to those in urgent or semi-urgent need but those who had been waiting for years for routine elective surgery.
Clinical need trumped all weightings which, as well as ethnicity, covered time waiting, deprivation, and geographic location. In services where the algorithm was used, it was not an absolute, with clinicians having the final say.
Spooked by the clamour, instead of standing the Government’s ground on this small attempt to address health inequities, Prime Minister Chris Hipkins ordered a review of the algorithm to ensure ‘‘we’re not replacing one form of discrimination with another’’.
Were those so vitriolic about the use of this algorithm truly unaware of the plethora of data showing poor health outcomes and shorter life expectancy for Māori and Pasifika and difficulties in access, including for specialist appointments? How many in need don’t get near a surgical waiting list because they can’t get to a specialist?
Those banging on about ‘‘equality’’ say nothing about the fact that since the early 2000s, the bulk of Vote Health billions was allocated to district health boards around the country under the Population Based Funding Formula (PBFF) which does not allocate the same funding to every person.
Funding is given for each member of the population based on an expected average yearly cost per person.
These are called cost weights and take account of age, gender, ethnicity (in priority order Maori, Pacific, other) and deprivation.
To assist with fairness, three adjusters were introduced to compensate the DHBs for differences in cost associated with servicing rural areas, overseas patients, and meeting unmet needs in Māori, Pacific and deprived populations.
When I was a health reporter, more than a decade ago, there was considerable concern in Otago/Southland about the adequacy of the rural adjuster. No-one we quoted on that issue attracted angry outbursts from townies upset rural folk might be wanting more than their fair share of the health funding pie.
Nor did we have politicians jumping up and down about ethnicity being included although I recall some concern about the quality of ethnicity data and how that could be improved.
Apparently, National leader Christopher Luxon does not consider there is anything systemic in the health system which has worked more against Māori and Pasifika than anyone else and believes that if only we dealt with poverty and social deprivation everything would be fine.
He needs to do some homework. Wilful blindness on this issue is lazy, dangerous and cynical, and smacks of desperation to lure wannabe Act voters.
Isn’t it time we all moved on from Don Brash and iwi/Kiwi?
The last PBFF review in 2015 considered whether the variables in the cost weights were still relevant. It kept them, saying there was substantial evidence both ethnicity and socioeconomic status should be included, as health disparities were not due solely to socioeconomic factors.
The PBFF is still in place, for now, but Te Whatu Ora Health New Zealand says change is required as new funding models are developed aligned with the health reforms. Work is under way on this, including understanding the variability of services previously provided in order to support future funding arrangements which concentrate on equitable access and outcomes, along with clinical and financial stability.
There was always murkiness around exactly how the PBFF worked, but HNZ chief financial officer Rosalie Percival says the transparency of new funding models ‘‘will be an important aspect of our approach to implementation’’.
I hope so. HNZ has much to learn on transparency, as did the previous managers of the health system.
My expostulating has meant I postponed the topic I was going to cover this week — the unfairness of the postal system for rural people.
Now there’s something you might expect National to be shouting about.
- Elspeth McLean is a Dunedin writer.
