Will funding boost for Māori health providers continue?

In a rare piece of positive news, today I learned Māori health expenditure has increased by at least 68 per cent between the 2018/19 financial year and the 2022/23 financial year.

But is it cause for celebration?

In mid-April, Manatū Hauora Ministry of Health released its regular reporting on funding to Māori health providers, Funding to Māori health providers, 2018/19 to 2022/23. ¹

These reports have been published online in some form since 2017 and have appeared annually since 2021. They are valuable as part of monitoring Crown support to Māori health providers and give us a sense of how government priorities are translating into funding decisions.

This latest report tells us there are more Māori health providers than ever. Manatū Hauora has identified 310 Māori health providers nationwide, which is 20 more than in 2021/22.

The report looks at Māori health provider funding in two main ways.

First, looking at funding for health and disability services, excluding capitation payments (for example, PHO funding and funding to Māori GPs) and excluding COVID-19 payments, Māori health provider funding has increased by $213.6 million between 2018/19 and 2022/23. This equates to a 68.9 per cent increase in Māori provider funding.

Next, looking at other types of Crown funding to Māori health providers (for example, PHO funding, GP funding and COVID-19-related payments), Māori health provider funding has increased by $196.1million (or over 200 per cent).

COVID-19 payments make up a large proportion of this increase and, in fact, the COVID-19 funding data makes the whole thing hard to interpret because there was no COVID-19 funding in 2018/19, for obvious reasons.

Māori PHO payments are the other big increase – more than doubling since 2018/19 (an increase of $94.2 million). For Māori GP payments (those not part of Māori PHOs) the increase was more humble, around $6.7 million or 40 per cent.

In total, combining both calculations, funding to Māori health providers has doubled between 2018/19 and 2022/23, increasing by $409.7 million.

For context, over the same period, the overall health budget (Vote Health) has increased by $4374 million, or 26.1 per cent. This means that Māori health funding has increased proportionately more than Vote Health.

It is this lack of certainty for what the future holds that ultimately means it is hard to celebrate an increase in funding that occurred under a Māori health authority that no longer exists

This is incredible in contrast to the report Funding to Māori Health Providers by the Ministry of Health and District Health Boards, 2011/12 to 2015/16, which showed Māori health funding from DHBs had not kept pace with overall increases in Vote Health funding (akin to pay increases being less than the rate of inflation).²

On the face of it, this new data looks to be cause for celebration. And I will agree that it is good news, but celebration might be a step too far as the results have to be read with caution.

There is a clear correlation between our COVID-19 response as a country and the increase in funding to Māori health providers. Some, if not all, of this funding will be time-limited and is likely to end within the next few years.

There was already a decrease in COVID-19 related funding between 2021/22 and 2022/23 of around $35 million.

The PHO funding, which doubled over the period of the report, is also hard to decipher. It could be that the increase in funding is a reflection of more practices joining Māori PHOs, in which case the evidence we have suggests that the increased funding may not meet the increased costs given some calculations, for example, those carried out for the Wai 2575 claimants³ , that show Māori PHOs are significantly under-funded in the first place, given the populations they serve and their focus on achieving equitable outcomes.

There are also only a few Māori PHOs (by my count, five), and they vary significantly in size, with some serving close to 10,000 enrolled patients and others serving hundreds of thousands of enrolled patients. It is impossible to tell from this report whether the increases were across the board (all Māori PHOs had an increase) or if it was only one or two PHOs that had increases.

This also highlights another weakness of this report, compared to previous years; it does not provide any data broken down by geographic region.

In all previous reports we were able to compare Māori health funding by DHB. This often made for very interesting reading. Last year, for example, it showed that even though Capital & Coast DHB had the highest increase in Māori health funding (an increase of 82.8 per cent), it was starting from a low base (back in 2017/18, Capital & Coast spent about $5.5 million on Māori health providers, less than most other DHBs). And Whanganui DHB had actually decreased its funding to Māori providers over this same period by $500,000. The 2021/22 report also showed that Waikato DHB increased its Māori health funding by $33.3 million, to $81.5 million, making it the DHB with by far the most Māori health funding. In fact, by 2021/22 only one other DHB (Northland) was spending more than $33.3 million a year (let alone increasing it by that much).

However, the real reason to be cautious with this report is that it covers the first year of operation for Te Aka Whai Ora and is vulnerable to change now that this agency has been disestablished.

Māori provider funding increased by $76 million in the first year of Te Aka Whai Ora. This apparent focus on Māori providers is consistent with the aspirations Māori had for a Māori health authority that was able to commission services directly.

Minister of health Shane Reti has said disestablishing Te Aka Whai Ora is not an end to the Government’s focus on Māori health. Dr Reti has also said: “We know the solutions for Māori communities come from Māori communities – not a centralised Māori hub”⁴ , which in the most generous light I can give it, could signal that funding for Māori providers that work with communities will continue. This is by no means, however, a guarantee.

And it is this lack of certainty for what the future holds that ultimately means it is hard to celebrate an increase in funding that occurred under a Māori health authority that no longer exists.

My take-home message is that the increase in funding that we have seen over the past five years has been positive, but we simply do not know if it will be enduring or whether it has been enough to meet the needs of the population served by Māori providers.

This will be the real test for the Government and for Te Whatu Ora as it navigates its newly expanded role that more directly relates to Māori health provider funding.

Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is an independent health policy consultant