The Press

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.

- Professor Peter Crampton is a researcher and lecturer at the University of Otago, and a member of the Expert Advisory Group for the claimants who commission­ed an analysis of the costs of underfundi­ng Ma¯ ori primary health care organisati­ons.

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.

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