Editorial - Sept 11, 2012

Te Hau Ora o Te Hiku o Te Ika's decision to waive fees for its enrolled patients under the age of 18 will be great news for many teenagers and their families. There is no doubt the cost of visiting the doctor is prohibitive for some, and waiving fees should go some considerable way to ensuring those aged under 18 receive the treatment they need in a timely fashion, rather than waiting until their problems worsen and greater intervention is needed.

The timing of the decision, following as it did the news that erstwhile Te Hiku GP Dr Lance O'Sullivan and his wife are planning to open a general practice in Kaitaia before the end of the year, is interesting, however. On one level it can be seen as a natural progression for a trust that, unlike any other general practice in Kaitaia, does not function purely as a business. Already dental care is provided free for those aged up to 17 by a trust-allied dental practice in Kaitaia, and now Te Hiku Pharmacy has also broken new ground in that it operates as a registered charity.

These can be seen as innovative moves to address pressing health needs in the very Far North. The decision to offer free treatment to those aged under 18 can also be seen as deeply cynical, however, directly aimed at putting the kaibosh on Dr O'Sullivan's plans before they even get off the ground.

If that is the case then the credit goes to Dr O'Sullivan. Assuming that free treatment to those under 18 continues regardless of what he does in the future, he can claim to have achieved something quite remarkable at a time when all sorts of people talk about the lack of access to health care for Maori but very few do anything about it.

Whether this will affect his plans to open a surgery in Kaitaia remains to be seen. There are certainly plenty of people who devoutly hope that it will not. Dr O'Sullivan is widely regarded as a skilled, empathetic GP for whom treating patients overrides all other considerations, and even before he announced his plans to open a surgery it was clear that many Te Hiku patients intended to follow him, if the opportunity arose. It is not believable that the trust that governs Te Hiku was not aware of that sentiment, and doubtful that the decision to treat those under the age of 18 free was not a deliberate response.

Whether it works remains to be seen. Dr O'Sullivan has made it clear that if he does open a surgery he will continue to give patients' needs a higher priority than their ability to pay; last month he said he was not expecting to be inundated with impecunious clients, but was hoping to prove that there were ways of serving high-needs patients without going broke. He may now need to assess whether there are ways of operating a practice while his former employer treats those under 18 free of charge without going broke.

Dr O'Sullivan has thus far declined to speak about the issues that led to his parting company with Te Hiku, but there seems little doubt that treating patients free was at least one factor, even if trust chairman Dr Bruce Gregory has refuted his reported claims that he had been warned about making house calls and treating patients who could not pay. Rather, Dr Gregory said, he had been asked to allow Te Hiku's administration to find solutions for those who were having difficulty paying, as they were most familiar with the options available, including free services. The fact that Te Hiku was carrying $67,000 in unpaid patients' fees showed that it had put patients' needs first.

Dr Gregory added the trust was pleased that Dr O'Sullivan would not be lost to health care in Northland, although a decision that will clearly tempt many of his potential clients to stay with or move to Te Hiku suggests that it was not so pleased that it was above making a move that one imagines will severely impact on a rival practice's ability to survive.

At the end of the day, the most important people in all this are the patients, whoever is treating them, or, more importantly, not treating them because they can't afford the fees. If Te Hiku's offer to those aged under 18 results in more teenagers receiving medical treatment earlier then that has to be a good thing, but there is a whiff about this that is not entirely savoury. For all the patient loyalty Dr O'Sullivan clearly has to call on, money will talk. Whatever happens over the coming weeks and months, if families find that they can get a better deal for their children at Te Hiku than they can from Dr O'Sullivan then that's where they will go. Dr O'Sullivan will have made a major contribution to the health of young Far Northerners, but at great cost to himself.

Dr O'Sullivan's obvious passion for improving the lot of Maori in terms not only of health but in education, justice and other areas, is commendable, but based on data that are flawed, and will become increasingly flawed as time goes by.

Dr O'Sullivan argued in this newspaper last week that the health of indigenous peoples generally is poorer than that of others, citing the disproportionately high rates of chronic ailments such as diabetes, heart and lung disease, cancers and infectious diseases among indigenous populations in countries such as Canada, the US, Australia and New Zealand. Most seriously, he said, indigenous peoples in those countries suffered a form of post-traumatic stress disorder.

The solution, or at least part of the solution, was to give indigenous New Zealanders a greater share of public health spending. Given that heart disease, the biggest killer of New Zealanders, claimed 2.5 indigenous lives for every non-indigenous life, spending on Maori should equate to 2.5 times the spending on non-Maori.

Just how that might work is not clear. One would assume the spending referred to covers everything from education about diet and lifestyle to open heart surgery, spending that one cannot easily see being allocated on the basis of race. And it is the basis of race wherein the real problem lies.

Statistics NZ can provide numbers for almost everything, except an accurate count of New Zealand's population that can claim Maori ancestry. Dr O'Sullivan should be saying that 2.5 people who identify themselves as Maori die of heart disease for every of those who don't. Not all those with Maori ancestry claim it, a fact that skews every Maori statistic, and in terms of death rates means Dr O'Sullivan is actually short-changing himself.

There is no doubt those who identify as Maori suffer health problems on a greater scale than the general population, but the solution to that does not lie in allocating health funding according to ethnicity.

There is one other factor that makes a special case of this country, at least in terms of comparison with Canada, the US and Australia - namely assimilation.

There has been very little assimilation in Canada, the US and Australia. The distinction between Maori and Pakeha in New Zealand is much less clear; in fact no distinction can properly be drawn at all. Statistics NZ certainly can't. That's a good thing. And in terms of health funding, the goal should be to see those who need it receive it, whatever their ethnicity.