The cost of failure to deliver on health promises to Māori

Wednesday, 1 September 2021

What are Māori health inequities? The Ministry of Health lists them. (First published June 2019.)

OPINION: 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 Māori and Pākehā 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; what matters here is the fact of the failure, and the consequences of that failure.

Enter the claimants to the Waitangi Tribunal in 2018. The job of the tribunal is to hear claims of alleged breaches by the Crown of the principles of the Treaty of Waitangi. The claimants in this case are a group of leaders of Māori primary health organisations, who argued that the failed implementation of the Primary Health Care Strategy led to chronic underfunding of their organisations that in turn had severe effects on the health status of their Māori patients.

Registered Nurse Mairi Lucas visiting patient Muriwhenua Pio in October last year. Lucas provided evidence to the Waitangi Tribunal about the discrimination she experiences as a Māori nurse.

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Peter Crampton is a researcher and lecturer at the University of Otago. In 2018 he gave evidence to the 2018 Waitangi Tribunal, on alleged failures of the Crown to properly implement itâs 2001 Primary Health Care Strategy. In 2020-21 he was a member of the Expert Advisory Group for the claimants who commissioned an analysis of the costs of underfunding MÄori primary health care organisations.

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 Primary Health Care Strategy? In order 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 Māori primary health organisations actually received by way of funding? How much less was this funding than what was required to address the high level of need of their patients? What would it have taken to implement the strategy for Māori 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 Māori 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 those policies.

What then is the bill presented to government, taking into account the human and monetary costs of the failed implementation of the Primary Health Care Strategy? The cost of underfunding and under-provision of primary health care for Māori is borne by Māori, and is measured in disease, sickness and death. The dollar equivalent cost of poor health and deaths for Māori over an 18-year time period that may be attributable to failed policy implementation is in excess of $5 billion a year. The cost in dollars for a test population of four Māori primary health organisations suggests that the funding formula underfunded those organisations over an 18-year period by between $346 million and $412m in total.

If the promise of the strategy had fully come to fruition for Māori, we would expect government to be investing up to $1b a year in Māori primary health organisations.

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 Māori primary health organisations and prevented them achieving necessary and important health policy objectives directed at securing good health for Māori.

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 Māori comes at a huge cost for Māori 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.

Professor Peter Crampton is a researcher and lecturer at the University of Otago. In 2018 he gave evidence to the 2018 Waitangi Tribunal on alleged failures of the Crown to properly implement its 2001 Primary Health Care Strategy. He was a member of the panel that reviewed the health system on behalf of the Government (the Simpson report), and in 2020-21 he was a member of the Expert Advisory Group for the claimants who commissioned an analysis of the costs of underfunding Māori primary health care organisations.