She is right that the system has moved, but according to many experts, backwards as a result of removing the ethnicity criterion.
The removal of this criterion was discussed by Professor Peter Crampton in a NZ Doctor article almost a year ago when the change to the funding formula was first announced on the back of a government-commissioned report by the consulting firm Sapere, published in 2022. The report concluded that a new formula should be implemented and should include age, sex, ethnicity, socioeconomic deprivation and morbidity.
Crampton went on to say that the expectation was that the Government would implement a state-of-the-art, fully fit-for-purpose formula, but it didn’t, instead changing it in an unexpected way.
By excluding ethnicity, the funding formula fails to properly reflect the underlying patterns of health need. As a result, we are left with an inferior formula because it does not take account of the measured health needs of Māori and Pacific families and communities and flies in the face of the fact that in epidemiological terms, ethnicity is one of the best indicators of need for healthcare.
That change to remove ethnicity as a factor also stands in stark contrast to a previous communication, by government circular, directing all public services to adhere to the principles of needs-based funding and service provision, acknowledging that funding for a particular ethnic group is justified as long as there is evidence of need.
In addition, in her article, Robinson fails to acknowledge that although the $120m going into primary care might be “new funding” for them, the bulk of it – $95m – comes from the budget allocated to hospital services, meaning the Health Minister is robbing an already starving Peter to pay a starving Paul.
She also fails to point out that the amount is also way less than the $614 million that Sapere thought was needed to cover practice losses and address unmet need for Māori, Pasifika and low-income families and does nothing to bring the overall funding package anywhere near that needed for this most important cornerstone of our health service.
All of this sits in a broader context in which the health system has been significantly starved of funds for over a decade, as shown in a recent paper, commissioned by Kaitiaki Hauora, and authored by Dr Bill Rosenberg and Dr Jackie Cumming.
There, they elegantly and clearly add up the progressive shortfall in funding that starved the health system during the Key years. That amounted to a staggering $25 billion and, under the current Government, the shortfall compared to the average spend of 16 comparator nations in the OECD is $1.1b a year. Rosenberg’s and Cumming’s research also shows that spending in primary care is only 5.5% of the total health spend, half that of other nations.
As a result of all of that, I was perplexed by the narrow scope of Robinson’s article, and couldn’t help but wonder if she is more interested in giving credit to the minister and his officials than in pressing them to address more important issues needed to improve the health of all of us.
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