Surgeons have expressed their support for the new surgical ranking system in order to address institutional bias.
Surgeons have expressed their support for the new surgical ranking system in order to address institutional bias.
The Royal Australasian College of Surgeons has spoken out about the new surgery wait-list rank system, explaining this isn’t about putting Māori and Pacific health above the health of other people, rather it’s about reducing existing health institutional bias.
Te Whatu Ora - Health New Zealand has introduced an Equity Adjustor Score, which aims to reduce inequity in the system by using an algorithm to prioritise patients according to clinical priority, time spent on the waitlist, geographic location (isolated areas), ethnicity and deprivation level.
Although the college did not have a hand in developing the scale, it supports its use as a means to provide “fairer access and treatment to surgical patients”.
Chairman of the Aotearoa New Zealand National Committee Associate Professor Andrew MacCormick said Māori and Pacific patients have poorer health outcomes compared to the general population due to long-standing inequalities.
“We know there are biases, including unconscious ones, in the current system which mean Māori and Pasifika have more difficulty accessing healthcare and don’t get offered the same level of treatment as the wider population,” MacCormick said.
“This means more ill-health and disability among these populations and ultimately a lower life expectancy.
“A major goal of the current health reforms is to reduce health inequities. We can’t do that if we don’t make positive changes that shift the dial away from institutional biases.”
Chairman of the Aotearoa New Zealand National Committee Associate Professor Andrew MacCormick. Photo / Supplied
MacCormick made the point that Māori and Pacific patients are already over-represented in the portion of the new equity adjustor aimed to help the most, the so-called long waiters (those waiting more than 365 days for surgery).
“This is not about putting Māori and Pacific health above the health of other people in Aotearoa New Zealand,” MacCormick said.
“It’s not a zero-sum game. Elevating those groups that have been less well-served by the health system is a benefit to everyone. It means improved health across the population and the targeting of healthcare to those individuals who need it most.”
Health officials said ethnicity was just one of five factors considered in deciding when a person gets surgery, and that it was an important step in addressing poor health outcomes within Māori and Pacific populations.
National’s health spokesman Dr Shane Reti, however, criticised the policy and said it should have no place in surgical priorities and is urging the Government to drop the criteria.
The National Party’s health spokesman Dr Shane Reti is calling on the Government to drop the ethnicity criteria. Photo / Mark Mitchell
“While there has been historical inequity that has disadvantaged Māori and Pasifika people, the idea that any government would deliberately rank ethnicities for priority for surgery is offensive, wrong and should halt immediately,” Reti said.
“The way to improve Māori and Pasifika health is through better housing, education and addressing the cost of living, not by disadvantaging others.”
Act Party leader David Seymour also opposes the use of ethnicity criteria and said if the other four criteria are working then “racial discrimination” should not be needed.
“The only possible effect of racial discrimination is to make sure a person in greater need waits longer for an operation and may die on a waiting list because they had the wrong ancestors,” Seymour said.
Act leader David Seymour said there is no need for a criteria based on ethnic groups. Photo / Marty Melville
Te Whatu Ora Auckland interim district lead Dr Mike Shepherd said they designed the point-like algorithm, partially based on ethnicity, because there was a gap for Māori and Pasifika between the time they present with symptoms, needing an operation through to actually getting that operation.
“We’ve been working to solve this and this is part of the solution,” he told Newstalk ZB’s Mike Hosking.
He said for Māori and Pasifika, they would maybe get one or two extra points out of about 100 because of their ethnicity.
“Our people want to get out of bed every day and ensure that all of our population is getting the best health care possible and this is part of that solution,” said Shepherd.
Shepherd said the algorithm first and foremost prioritised clinical needs.
“It’s not about getting to the front of the queue,” he said.
“It’s about adding some ratings and keeping an eye on the clinical prioritisation.”
Rachel Maher is an Auckland-based reporter who covers breaking news. She has worked for the Herald since 2022.
