Surgeons in Auckland, New Zealand are 'disgusted' over a new policy rolled out in February which requires them to address "historical disparities in healthcare access" for Māori and Pacific Island communities, which will be factored into a new ranking system that determines priority for surgical procedures.
According to leaked documents obtained by the NZ Herald, the new initative, implemented by Te Whatu Ora - Health New Zealand, uses an "Equity Adjustor Score" algorithm to assign priority based on clinical urgency, waitlist duration, geographic location, ethnicity and level of deprivation.
Patients of Māori and Pasifika backgrounds receive higher rankings, while European New Zealanders and other ethnicities are downranked.
Several surgeons spoke with the Herald, one of whom said he was "disgusted" by the new system.
"It’s ethically challenging to treat anyone based on race, it’s their medical condition that must establish the urgency of the treatment," said the surgeon, adding "There’s no place for elitism in medicine and the medical fraternity in this country is disturbed by these developments."
A document on the equity adjustor which was leaked to Newstalk ZB shows two Māori patients, both aged 62 and who have been waiting more than a year, ranked above others on the list. A 36-year-old Middle Eastern patient who has been waiting almost two years has a much lower priority ranking.
An email by Te Whatu Ora business support manager Daniel Hayes in April said: “Hi team, Heads up. This is going to be the new criteria for outsourcing your patients going forward. Just putting this on your radar now so that you can begin to line up patients accordingly. Over 200 days for Māori and Pacific patients. Over 250 days for all other patients.” -NZ Herald
Health Minister Ayesha Verrall defended the move, pointing to a Government-commissioned, independent review of the health system conducted in 2018, which found that the system produced unequal outcomes, particularly for populations deemed vulnerable.
"The reformed health system seeks to address inequities for Māori and Pacific people who historically have a lower life expectancy and poor health outcomes," she said.
Sir Collin Tukuitonga, a leading expert in Pasifika health, echoed Verrall's comments, saying Māori and Pasifika patients could be moved to the front of the line due to historical inequalities.
"Māori and Pacific people tend to linger on the referral list... and inevitably, I think people will say that there’s also an institutional bias, possibly a racism that doesn’t put them where they need to be in order to get the surgery," he said, adding "The referral pathways are not that straightforward."