Expert reaction: Health inequities between Māori and non-Māori adults cost NZ$863.3 million per year

Māori health inequity directly costs the health system $39.9 million per year, according to a new Indigenous-led study. When researchers added indirect costs of $823.4 million from lost years of life and lost wages, which were mostly borne directly by Māori whānau, the overall cost skyrocketed to over $863.3 million. Māori significantly under-utilised primary care, creating an annual saving to the health system of $49.4 million per year. The authors point out that these are conservative estimates, and say that the 'cost of doing nothing' about health inequity is predominantly borne by Indigenous communities and society - less than 5% of the cost is borne by the health system.

Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Dr Sarah-Jane Paine is a Senior Lecturer in the Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori at the University of Auckland and an author in the study.

"There was no estimate of the cost of adult Indigenous health inequities before this study. This study builds upon earlier work which found Indigenous child health inequities results in cost savings to the health sector and significant societal costs.

This highly conservative estimate not only shows that maintaining health inequities is costly, but provides a stark indication of who bears these costs. The study found health inequities for Māori adults cost $863 million each year, including $823.4 million per year from lost years of life and lost wages, mostly borne directly by Māori whānau. The costs include $66 million per year in excess avoidable hospitalisations, and we also found savings of $49 million per year in under-utilisation of primary care, and savings to the government of $26 million per year in lower access to ACC.

These figures are all likely to be an underestimate, because they only considered some types of costs, and did not assess whether Māori had higher health needs.

This study adds further weight to human rights and social justice arguments for addressing health inequities, and helps quantify the 'cost of doing nothing' for policy and decision-makers. It documents a clear breach of Indigenous rights.

This study also highlights that some parts of the health sector have no financial incentives to rectify Indigenous inequities in utilisation, for example primary care. Ultimately, the net impact for the government health sector is that it saves millions per year in underservicing Māori, even when excess hospitalisations are taken into account."

Professor Rhema Vaithianathan is in the School of Social Sciences and Public Policy at the Auckland University of Technology.
"The study is important in that it quantifies who benefits from under-serving Maori in the health system. The most concerning finding is that Primary Care system actually saves money by under-serving Maori. This saving is equal to $49m per year. Not surprisingly, the under-serving in primary care has a flow on effect in the hospital sector where Māori have excessive rates of avoidable admissions.

The ongoing problem in NZ has been, in my opinion, that whilst the DHBs and now Te Whatu Ora own hospitals, they don’t own primary care, which is and always has been privately owned. Under a capitation system, the business case for primary care to reduce inequity in the health system is simply not there. Perhaps its time to review the way that primary care is funded – through a higher mix of fee for service where GPs serve hard to reach patients."

Associate Professor Jacquie Kidd is in the School of Clinical Sciences at AUT.

"This is a hugely important piece of work that provides another piece of the picture of the consequences of health inequities for Māori. We have known for a long time that whānau feel a significant financial burden when a loved one is unwell and needs awhi and manaaki, as well as the costs associated with accessing care and treatment. This is in addition to the more tangible results such as the loss of work, and either premature retirement or early death. Understanding the dollar cost of such health inequities is vital to holding the health care sector accountable for generations of inaction. We should prioritise further research of this type so we can measure progress in our health equity efforts."