High needs demand high spending on Maori health

By CATHERINE MASTERS

If health funding is examined from a needs-based perspective then Maori should be getting more than they do. The Ministry of Health says funding formulas already take factors of need, not race, into account. And Maori indisputably have high need.

They are higher in just about all the wrong health statistics. They die on average 10 years earlier than non-Maori, suffer higher rates of all cancers other than skin cancer, and have higher rates of diabetes, heart disease and other conditions.

They do not access health care early and when they do get to hospital they are sicker.

Ministry figures show Maori received 14.7 per cent of the total health funding for last year - less than the Maori proportion of the population, which the ministry calculates at 15.24 per cent.

The ministry estimates that for children under 5, females aged 35 to 39 and people over 55 expenditure is considerably higher for Pakeha.

Through mainstream funding - funding available to everyone - about $1.1 billion out of $8.2 billion of total spending went on Maori health services with $136 million of that going to Maori health service providers.

Those providers cover a range of health issues for Maori, from whanau support to anti-smoking programmes. Non-Maori may access these services.

A Maori Provider Development Scheme allocates $10 million a year to support Maori health providers and workforce development.

The Maori health workforce is low at about 5 per cent, and only 3 per cent of 8000 general practitioners are Maori.

Last year Maori workforce development programmes received $3 million from the Clinical Training Agency, and the ministry invested $2.4 million in Maori mental health - another area of high need.

Funding for district health boards and public health organisations is reliant on various components that make up levels of health need.

The top category is age, not race: older people have higher needs so areas with high numbers of older people get more funding.

Deprivation and ethnicity are other components used to determine need.

Maori do not jump the queue in hospital waiting lists.. Because they do not access services early, the heart attack they suffer is more likely to kill them. Pakeha are more likely to receive intervention and stay alive longer.

Public Health Organisations, set up to offer cheaper primary health care, are also funded according to a needs-based approach.

Again, at the top of the list is age, but deprivation and ethnicity - Maori and Pacific - is also a factor.

PHOs with a high number of Maori and Pacific Islanders receive 20 per cent more, but that cheaper health care covers the whole population in that PHO, regardless of ethnicity.

District Health Boards are required to have two Maori on the board, to ensure boards have the knowledge to achieve statutory objectives of improving Maori health.

In the 2001 elections nearly 120 Maori stood for those boards, of whom five were elected. The other 51 were appointed by the minister.

Some Pakeha surveyed by the Weekend Herald believed Maori received special treatment in hospital, including separate rooms.

Health Minister Annette King says this is not Government policy, and the Auckland District Health Board says there is no such thing as separate provision for Maori. Everyone gets the same operations, the same basic service and the same food.

Visiting hours are no different and wards are mixed.

But care is taken to be culturally sensitive to all ethnicities.


She said Pakeha patients did not always understand they were in the predominant culture and some felt they were missing out when they saw others being treated differently culturally.

Staff do receive tikanga Maori training, ranging from spiritual needs to what to do with body parts, but sensitivity to all cultures is a long-accepted part of nursing.

Tauranga Hospital has a special kaupapa ward, set up under the National Government, designed to provide traditional Maori care.

But Pakeha are entitled to - and do - use it. The Waitemata District Health Board now offers an Asian Health Service, in response to the growing numbers of Asians living on Auckland's North Shore.

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