Is our health system delivering what it should? — another blow to equality

“Just recently an accident caused me to have to go to City Centre Medical Ltd to have a dressing changed after some minor surgery. This occurred on a Saturday. Even though the surgery was covered by ACC I was told I had to pay another $45.to have it redressed. I asked what would happen if I couldn’t pay to which I was told we will send you and invoice. I was speechless” said Peter Malcolm spokesperson for Closing the Gap Some research was required Malcolm .went on to say.

This research clearly shows that there are flaws in the current health system. Key themes such as declining doctor numbers; time pressures and expensive GP visits re emerge throughout mainstream news discourse. A survey by the Ministry of Health noted that 533,000 people stated that they could not afford to visit the GP 1 . A trip to the Dr ranges in price from $45 - $60 during the week, with additional charges outside working hours. Unaffordability is a barrier to primary healthcare and as a result there has been greater pressure on secondary healthcare, where some are admitted to hospital for issues that could have been treated earlier if seen by a GP.

It is interesting to look at figures from the Health Quality and Safety Commission regarding AHS (ambulatory sensitive hospitalisations) rates for children. High admission rates indicate “the difficulty in accessing care in a timely fashion, poor care coordination or care continuity, or structural constraints such as limited supply of primary care workers”.

Other factors that determine ASH rates are health literacy and overall social determinants of health. Data suggests that admissions were significantly higher for Maori and Pacific children .

Further findings from Health Quality and Safety Commission found that up to 40 percent of Maori and Pacific people with bowel cancer did not find out they had the disease until they needed emergency hospital care 3 . This is a clear indicator that equality across service and care throughout the country is needed.

Former MP, John Tamihere, encourages West Aucklanders to bypass after hours Doctors and go straight to hospital. This highlights the systemic concern that access to primary health care is unsatisfactory, especially after hours, where many simply cannot afford to visit their GP or other suppliers of medical assistance. Discussion has been raised to the notion of “after hours” health care, as afterhours is a concept used in the retail and commerce sector – and should not apply to healthcare 4 .

On a brighter note, the Hawke’s Bay DHB approved a proposal to extend free primary healthcare for those under 13yrs to 18yrs. Practices with the highest Maori population and those in less affluent areas were targeted to participate in the scheme. It is hoped that people in this age group will utilise primary healthcare more, and therefore less people will be using the emergency department as their first port of call. Free GP visits for under 18s are also available at some practices in South Auckland 5 .

Looking at cultural inequality, a study conducted by public health specialists at Massey University found that the mainstream health system fails to respond well to the needs of Maori cancer patients , as Māori tikanga – culture – is overlooked. As a result, patients feel uncomfortable when using the mainstream system and often keep information from their doctor in fear of being ridiculed. Figures from the Ministry of Health show that the rate of mortality from cancer is 1.5 times higher in adult Māori patients compared to non-Māori. It is suggested that the Ministry must analyse their outcomes more carefully and increase funding for better cancer outcomes to ensue..

An additional study gives the recommendation that GPs should collaborate more with traditional rongoa Māori healers, in order to give patients the best achievable healthcare. Researcher Dr Mark found tāngata whenua would prefer to have the option of receiving treatment from both their GP and healer. Unfortunately doctors’ lack of cultural knowledge and acceptance was proving to be a barrier. Professor Crampton, from the University of Otago stated that exposure to rongoa Māori for trainee doctors involved only a one-off session with a rongoa and agreed that change is needed.

It is evident that much more is needed to improve healthcare for all New Zealanders, especially Maori and pacific peoples and those on low incomes.

Access to primary healthcare is limited to many due to unaffordability and this gap needs to close. Greater investment, such as cultural awareness, education and increased funding will ensure a healthier and more equitable society in the long term, where all have the opportunity to engage with the health system when and where needed.

“Prerequisites for health are peace, shelter, education, social security, social relations, food, income, the empowerment of women, a stable eco-system, sustainable resource use, social justice, respect for human rights, and equality. Above all, poverty is the greatest threat to health”.

“It is clear that in New Zealand we are not delivering medical resources in a fair and timely fashion. How our present Government can even contemplate tax cuts when our health system is crying out for more funds. When this is looked at in the light of the fact that we are one of the lowest taxed countries of the developed world you have got to wonder have we lost our sense of fairness completely” says Malcolm.

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