A mother with a sick three-year-old is ringing around doctors’ clinics in Wellington looking for an affordable service. She has little luck because most clinics charge a fee.
At the same time in Porirua, several mothers are waiting anxiously at the reception area of the clinics, hoping their children will get to see a doctor soon.
These mothers from Wellington and Porirua have a common concern about the health of their children. They also have the extra burden of balancing very tight budgets.
It happens that the Wellington mother is a Pakeha while the Porirua mothers are all from low-income families of either Māori or Pacific descent. While the Porirua mothers are more likely to get their children seen by a doctor free of charge, the Wellington mother has fewer affordable clinics to go to.
It appears that Māori and Pacific people are favoured with affordable healthcare while other New Zealanders miss out.
Is this ‘race-based’ health funding?
Critics of the new primary health organisations (PHOs) have constantly complained that healthcare is not being funded on the basis of need, but by the ethnicity of the recipient.
However let’s turn to some facts that are not as visible as the mothers.
There is no difference in the government’s funding of visits to the GP in Porirua and Wellington for children under six years of age.
Regardless of where they live, or whether they are Māori or non-Māori, the medical care for these children is funded at the same rate – $36 per visit for up to nine visits per year.
What is different, however, is which particular clinic the under six-year-olds are taken to.
In Porirua 11 of a total of 14 doctors’ clinics (nearly 80 percent) do not charge a fee on top of the government subsidy. But in Wellington, only 10 of the 40 clinics (25 percent) waive the fee for these children.
Of the 21 clinics that provide free doctors’ consultation to children under six, nine are operating with a low-cost, not-for-profit philosophy. These nine providers have specific objectives to work with people who have poor health and who are missing out on services, and are from low-income backgrounds.
Four providers in this not-for-profit group have a Māori governance structure. What is not usually acknowledged is that more than half of their patients are non-Māori.
Over 90 percent of the patients turning up at the low-cost Porirua clinics are classified as high needs. Many come with complex and multiple illnesses requiring long-term treatment and careful monitoring.
On the other hand, the doctors’ clinics which do charge extra fees argue that doctors retain the right to do so. According to one doctor, doctors will not accept any government directive because they run a private business and they expect ‘to make a buck’.
Evidence we have examined so far does not reveal any race component because the basic funding for everyone’s visits to the doctor is based on age, gender, and relative health needs. The biggest factor determining the annual funding is the expected number of visits per year for that particular age group.
The subsidies for doctor visits are at least 80 percent of the total funding of PHOs and this funding has nothing to do with ethnicity.
Much research shows that particular widespread health needs (eg: asthma, heart disease, diabetes) have a relationship to deprivation and ethnicity.
If the health dollar is to be spent effectively, it is necessary to take this relationship into account. Ethnically targeted health funding is only a small proportion of total health funding and is aimed at spending the health dollar where the need is greatest – not for subsidising visits to the doctor.
This ‘high needs targeted’ funding is mostly used by the healthcare providers for health promotion activities for Māori and Pacific people, and everyone in high deprivation areas. The funding is also used to run outreach services so that more people can access the healthcare they need.
Evidence shows that the traditional GP and hospital system has largely failed to meet the health needs of Māori and other marginalised groups in NZ. However, health funding directed to the needs of particular high-needs or deprived groups (many Māori and Pacific people come into this range) is less than 10 percent of the total funding that PHOs receive. This is less than the total percentage of the Māori and Pacific population of New Zealand. The criticism of the targeted funding is clearly out of all proportion to the size of the funding.
Is this criticism a way of focusing on or scapegoating weaker groups to gain political advantage, playing on prejudices and distracting attention from other issues?
It might also be asked how powerful interest groups among doctors try to limit the amount of health funding going to high health needs groups or why Māori and Pacific people have not received the quality of treatment in our health system to which they are entitled?
Catholics are challenged to look at the structuring and aims of particular social programmes and to evaluate them in the light of Catholic social teaching.
Three main principles
The first principle is fair access to the world’s goods for all people. This applies especially to public goods (housing, health, education, water, etc).
Secondly the principle of participation: that all people have a right and a duty to participate in seeking the common good through the policies and institutions of their society.
Thirdly the ‘preferential option for the poor’ – in looking at how society, the Church and government programmes operate, we take the perspective of the poorest or most marginalised.
Our reflection as Wellington Catholic Peacemakers suggests that the current primary healthcare strategy is a genuine attempt to address inequality in health. It is also consistent with the principles of Catholic social teaching.