Maori Party Health Policy and Analysis thanks to NZ Doctor Online
Under Māori Party policy, state funding of visits by Māori to general practices would be via a new health card.
Māori would be issued with the card, which would be linked to their National Health Index (NHI) number, and would present it to the practice of their choice, enabling state funding to flow there.
“We would put the patient at the forefront, rather than the professionals and the practices,” says party co-leader John Tamihere.
Asked if this was a fee-for-service model that would mean carving Māori out of the capitation funding formula, he says practices should only be paid a fee for service, “not fee for capture”.
He says that in Auckland, 30,000 Māori people are not enrolled for primary care.
Other planks of the party’s health policy are to:
Establish the Māori Health Authority (MHA) recommended by the Health and Disability System Review and giving it the power to commission and fund services for Māori. It would be given a budget of $5 billion, nearly a quarter of Vote Health 2020/21.
Create a Kaupapa Māori Mental Health Service, which would develop a Māori mental health and addictions strategy. The MHA would buy services in line with the strategy, using $500 million of existing mental health funding. The party’s health policy document says a focus of this new service will be to reduce the suicide rate of Māori, “one of the highest suicide rates amongst any people in the world”.
Reduce the Māori entry age into cancer screening programmes by 10 years.
VERDICT
From Esther Willing, of Ngāti Toarangatira, Ngāti Koata and Ngā Ruahine, a lecturer at Kōhatu – Centre for Hauora Māori, University of Otago:
“Their proposals are, I think, really positive and focus on what will lead to better health outcomes for Māori.”
“The health card and the idea that funding of Māori people would follow them rather than the providers is an interesting policy proposal because the focus is on the people rather than what works or is best in terms of funding for providers and the health system.”
“It would be a big change in how we fund primary care services. We have had capitation funding for 20 years. People are used to this being the way it is…If we know Māori have difficulties accessing primary care services in their community, we need to find ways of addressing those challenges that aren’t being met by the current funding system.
“It’s an area we need to have a conversation about. We know that even with targeted funding for Māori health going to providers, in many cases it’s not making it easier for Māori whānau to be able to access those health services. There are barriers to enrolling with a primary care provider, being able to get timely appointments to see a GP and having to use emergency doctors or the emergency department to be able to access health services.”
“Current funding structures aren’t reaching most Māori whānau who have the highest health needs and probably face the most barriers in accessing health services.”
Dr Willing says the proposal to lower the Māori eligibility age for cancer screening programmes makes sense because of known inequities.
And she agrees with the party’s Māori Health Authority proposal, saying without full funding powers, “it won’t have the mana or authority to be able to improve Māori health outcomes”.
“Creating a Kaupapa Māori Mental Health Service highlights what we already know: there’s a massive challenge in Aotearoa New Zealand around mental health and access to mental health services.”
“They are proposing shifting funding to a Kaupapa Māori Mental Health Service with the idea of being able to fund and develop services that are grounded in a kaupapa Māori approach.
“We know our current mental health services aren’t addressing Māori mental health needs, especially around suicide for young people, young men and so there have been a number of kaupapa Māori mental health initiatives that have been able to show they have been able to make a difference for the communities they are working with. But they struggle with funding under a mainstream system, so having a Kaupapa Māori Mental Health Service that focuses on supporting those community-led…services is a really good idea.”