Formula proving underfunding of Māori healthcare in the billions released to government to address inequity

The level of underfunding of Māori Primary Healthcare provided ‘by Māori’ has finally been calculated in a ground-breaking 66 page document released to the Crown today.

The report was commissioned by six Waitangi Tribunal Claimants (Wai 1315 and Wai 2687) who, along with several members of the Expert Advisory Group to the report, briefed the Minister of Health and Associate Minister together late last week.

The government was also asked to commit to negotiating compensation with the Māori Health Organisations.

The findings by independent research group Sapere were based on extensive evidence extrapolated back to 2003 and provide a robust formula that indicates significant historical underfunding to Māori Primary Health Organisations and providers.

To demonstrate the magnitude of the underfunding, the report calculates that for a group of Māori providers with an enrolled population of 332,051, the losses could be as high as $531 million (i.e. this calculation is based on a test population only, and not the Māori population as a whole).

The report also indicated that the proper investment into sector leading ‘by Māori’ primary healthcare was $1 billion per year and the cost to the country of not making this investment has been $5 billion per year.

It also calculated the level of investment required to achieve the promises made in the 2001 Primary Health Care Strategy and the cost of the significant inequities borne by Māori.

“The government has known about this deficit for years. It admitted it to the Waitangi Tribunal but didn’t do anything so now is the time to put that wrong, right,” says Lady Tureiti Moxon, Chair of the National Urban Māori Authority.

The Crown’s dismal record of health delivery for Māori is an indelible stain on this nation’s reputation according to a Waikato Tainui aligned Claimant.

Taitimu Maipi says, “the pursuit of Mana Motuhake and the ability for Māori to lead and implement health initiatives for its people has always been the primary motivation.”

Another Claimant, Ms Janice Kuka Managing Director of Ngā Mataapuna Oranga has witnessed first-hand the impact on whānau and hauora Māori that have carried the social and financial burden of an underfunded health system.

“This inequity was constantly made known to the government. They in turn have ignored us or put in place numerous working groups that went nowhere. This report now places more value on our future,” Ms Kuka says.

Fellow Claimant, Simon Royal, Chief Executive of the National Hauora Coalition believes the report backs up the 2019 Waitangi Tribunal findings.

“The report shows the significant funding challenges we and other Māori providers have faced since 2002 while we aim to deliver primary health care services that actually work for whānau Māori,” Mr Royal says.

The Claimant group that comprised Lady Tureiti Moxon, Janice Kuka, Taitimu Maipi, Hakopa Paul, Simon Royal and Henare Mason expect the report will lead both to continued discussions with the government and Ministers’ over compensation for the underfunding; and should be a baseline for the government in determining funding for a new Māori Health Authority.

A future focus that’s self-determining is echoed by Mr Maipi.

“This report gives independent findings to our claims we advocated in the Waitangi Tribunal, that Māori bore the brunt of a failed and racist New Zealand health system. Let's bring on the health reforms that are Iwi/Māori designed, owned and operated," he says.

Redress is also on the minds of others.

"My tūpuna of Ngāti Pikiao were humiliated and accused of fraud by the Crown trying to stand up a Māori Primary Health Organisation. This report validates, in the very least, an apology to my Iwi," says Hakopa Paul.

“Our view is that this report resets and recalibrates how Māori health is valued. It offers a principled funding framework to support the new Māori Health Authority to succeed. We’ve used an approach that the government already use as standard practice,” Lady Tureiti says.

Background information

In 2019 the Waitangi Tribunal identified breaches of Te Tiriti o Waitangi when it came to the Crown’s design and implementation of its primary health care framework.

Māori providers were seen as crucial to a successful Primary Health Care system, but despite this the Waitangi Tribunal found they had been underfunded from the outset[1] and that funding arrangements systemically disadvantaged primary health care providers who were delivering services to the parts of our population with the highest need.

However, quantifying the level of underfunding was outside the scope of the Tribunal Inquiry and instead it was made one of two interim recommendations for immediate action.

The report, which was prepared by independent research group Sapere, identified three core areas of calculation:

· Result 1. The cost of historic direct underfunding - The Māori Primary Health Organisations and providers in a test population have been underfunded between $394-531 million since 2002;

· Result 2. The investment required to achieve the promises made to Māori in the 2001 Primary Health Care Strategy - Providing comprehensive ‘by Māori for Māori care’ to all Māori would cost between $891 million and 1.06 billion per year;

· Result 3. The cost of inequity in health outcomes suffered by Māori: The cost (borne by Māori and the New Zealand economy) of not funding ‘by Māori for Māori’ care has been $5 billion per year.

The assumptions in the underfunding report were also reviewed by an Expert Advisory Group chaired by Neil Woodhams ONZM and that included Dr Jim Primrose, former Chief Advisor, Primary Care at the Ministry of Health, Professor Peter Crampton, former Dean of Otago Medical School and now Professor of Public Health in Kōhatu, the Centre for Hauora Māori at the University of Otago and other claimant representatives.

The Project was managed by Sharon Shea who also chaired the Māori Expert Advisory Group to the HDSR Expert Review Panel and is currently the Chair of the Bay of Plenty DHB.

[1] Waitangi Tribunal (2019) Hauora Report, page xiii https://forms.justice.govt.nz/search/Documents/WT/wt_DOC_152801817/Hauora%20W.pdf