Health failures to Maori – the numbers
The cost of the failed implementation of the government’s Primary Health Care Strategy for Ma¯ori providers has been quantified. It’s huge, says Peter Crampton.
Seldom has the Government been presented with a bill for failing to deliver on its health policy promises. This is exactly what happened recently, and it’s a big bill. Twenty years ago the then Labour government announced a large sweep of changes, including the formation of primary health organisations mandated by the Primary Health Care Strategy. One of the intentions was to reduce health inequities between Ma¯ ori and Pa¯ keha¯ through the provision of culturally appropriate primary care services provided by teams of health professionals working in communities.
This was, in my view, a strong and purposeful piece of policymaking. But it soon became apparent that the implementation process was not properly achieving the stated policy aims. The explanations for this failure can be debated later; what matters here is the failure, and its consequences.
Enter the claimants to the Waitangi Tribunal in 2018. They in this case are a group of leaders of Ma¯ ori primary health organisations, who argued that the failed implementation of the strategy led to chronic underfunding of their organisations that in turn had severe effects on the health status of their Ma¯ ori patients.
The tribunal made an interim recommendation that the Crown and claimants work together on how to calculate the extent of the alleged underfunding. In the event the claimants commissioned and led the work with seemingly little Crown involvement.
So what are the human and economic costs of the failure of implementation of the strategy? To answer this, analysts from consultancy Sapere, with oversight by expert advisers, answered a number of subsidiary questions.
Over the 18 years since the strategy was launched, what have Ma¯ ori primary health organisations received by way of funding? How much less was this than what was
required to address the high level of need of their patients? What would it have taken to implement the strategy for Ma¯ ori health services in a way that fulfilled the promise of the strategy? And finally, what is the equivalent monetary cost of the health burden experienced by Ma¯ ori that could have been addressed through proper implementation of the strategy?
The work carried out by the claimants and consultants in answering these questions lays bare the costs of making policies to address service failures and then failing to properly implement them.
What then is the bill presented to government, taking into account the human and monetary costs of the failed implementation of the strategy? The cost of underfunding and under-provision of primary health care for Ma¯ ori is borne by Ma¯ ori, and is measured in disease, sickness and death. The dollar equivalent cost of poor health and deaths for Ma¯ ori over an 18-year period that may be attributable to failed policy implementation is in excess of $5 billion a year.
The cost for a test population of four Ma¯ ori primary health organisations suggests the funding formula underfunded those organisations over 18 years by between $346 million and $412m in total.
There are two main implications. First, I imagine there will be claims for compensation for the Crown’s failure to deliver on policy commitments. Without doubt this failure has disadvantaged Ma¯ ori primary health organisations.
Second, there are clear messages for the Government and the leaders of our system as we move into a period of substantial health reform. There are some important lessons to be learnt from both the principles and the technical aspects of the report. Unfairness against Ma¯ ori comes at a huge cost for Ma¯ ori and for society in general. These are weighty considerations in light of the Government’s current ambitious health care reforms that aim to fix past failures.