Waitangi Tribunal: Lack of action on Māori health underfunding as health gaps grow
Monday, 18 October 2021
The health gap between Māori and non-Māori continues to grow while Waitangi Tribunal claimants wait for the Crown to agree on a way to measure decades-worth of underfunding in Māori health.
The Waitangi Tribunal has released its final recommendations from its stage one of the Health Services and Outcomes Kaupapa Inquiry. Its first recommendations, released in 2019, included a call for the Crown and claimants to agree on a way to assess how much Māori primary health providers had been underfunded.
“After more than two years we are disappointed that no agreement has yet been reached and especially disappointed that this is largely due to the Crown not engaging with the claimants on this issue,” presiding officer Judge Damian Stone (Ngāti Kahungunu) wrote in its final report released on Tuesday.
“The longer this crucial work is delayed, the more prejudice Māori have already suffered as a result of ongoing health inequalities is exacerbated.”
**READ MORE:
* The cost of failure to deliver on health promises to Māori
* Government's DHB overhaul is the latest salvo in the Wellington vs local control war
* The public health overhaul that had to happen
**
Its fellow authors associate professor Tom Roa (Ngāti Maniapoto, Waikato Tainui), professor Linda Smith (Ngāti Awa, Ngāti Porou), and Tania Te Rangingangana Simpson (Tainui, Ngāi Tahu, Ngā Puhi), wrote they “cannot comprehend why – after more than two years, and despite the Crown having managed to design an entirely new health system in that time – it has failed to substantially progress this critical work on underfunding”.
Māori die seven years younger than non-Māori, a fact health experts have said results from inequities in the system largely caused by institutional racism.
The claimants commissioned their own independent report by Sapere which found Māori healthcare was massively underfunded by up to $531 million since 2003. It found $1 billion in extra investment a year would save the country $5b annually in health-related costs.
The claimants represent several Māori health providers and primary health organisations.
General practice is funded by the amount of patients on its role, not the number of times a patient sees a doctor, and the sum doesn’t account for socio-economic deprivation. It also is funded through the co-payment, a fee patients pay which is capped by the Government.
The Crown wasn’t yet able to substantively respond to the Sapere report but accepted funding streams needed to change, the report said.
Health Minister Andrew Little announced sweeping plans to replace the 20 District Health Boards with one national health body, Health New Zealand, to fund and run the health system alongside the new Māori Health Authority in April.
Officials would draw on the Sapere report when setting the new Māori Health authority’s budget. Exploring the possibility of a Maori Health Authority was one of the tribunal’s recommendations but Little’s creation of one went further than the recommendation.
However, the authority needed to be funded adequately and given enough power to ensure it has “meaningful impact” while it was tasked with “arguably the hardest job of any of the central health agencies”, the report said.
“It will be expected to advocate for the equity agenda when the other central health agencies have dropped the ball. It will be expected to intervene in the worst-performing services of the health system, and improve them, including services offered by so-called ‘mainstream’ providers,” the authors wrote.
The report said the underfunding methodology needed to be agreed upon “with even greater urgency” than when it was first recommended in 2019.
The inquiry also found multiple Treaty breaches and little improvement in Māori health outcomes despite the Crown investing some $220 billion into the health system since 2000.