Surgeons in Auckland, New Zealand, are expressing discomfort with a new policy that requires them to consider the ethnicity of their patients as a factor when scheduling surgeries.
Specifically, Maori and Pacific Islander patients are given priority consideration to compensate for historic inequality in access to health care.
Te Whatu Ora – Health New Zealand, a national public health agency established in July 2022 to consolidate numerous regional health boards, introduced an “Equity Adjustor Score” that sets five factors to be considered in surgery priority lists.
The five factors are clinical priority, time already spent on wait lists, if the patient lives in a geographically isolated area, economic deprivation, and ethnicity. The highest scores for ethnicity are given to Maori and Pacific Island (or “Pasifika”) peoples.
A similar concept was introduced in the Wellington region in May 2020. Capital & Coast District Health Board medical officer John Tait insisted it was “unlikely that any other patients will be significantly affected as a result” of the rules prioritizing Maori and Pasifika candidates for surgery.
The NZ Herald said on Monday that several regional boards saw the Wuhan coronavirus pandemic as a “Big Bang opportunity to reset” the unequal healthcare system, as former Auckland board chair Pat Snedden said in May 2020. Various attempts to adjust medical access for ethnicity were introduced without much public fanfare during the pandemic.
After explaining that the ethnic score would be employed to assign slots “within a given clinical priority band” – in other words, with all other considerations of severity being equal, Maori and Pasifika patients would go first – Tait clarified that his health board would “increase planned surgery overall” to “offset” any inconvenience to other ethnicities.
The Equity Adjustor Score for Auckland was devised in February but was not implemented until this week.
Te Whatu Ora’s interim leader for Auckland, Dr. Mike Shepherd, said that Maori and Pasifika patients have a “longer pathway to get on a waiting list in our current system,” so the ethnic scoring is an effort to correct for that delay and put them on a timetable from illness to surgery that is roughly equal to other groups.
“These adjustments are based on evidence which shows these groups often have inequitable health outcomes which often begin at the start of their healthcare journey. Clinical teams work in close collaboration to implement the adjuster, with clinicians making the ultimate decision about the wait list,” Shepherd said.
Other Auckland health experts noted the Maori have life expectancies that are about seven years less than the national average, due in part to their limited access to specialized medicine. Chief medical officer Dr. Rawiri Jansen of the Maori health agency, Te Aka Whai Ora, estimated Maori are running one to two years behind other patients in diagnosing their illnesses and scheduling surgery.
The NZ Herald reported on Sunday that some Auckland surgeons are “upset” by the ethnic preference policy, describing the Equity Adjustor Score as “medically indefensible.” One surgeon said he was “disgusted” by the policy.
“It’s ethically challenging to treat anyone based on race, it’s their medical condition that must establish the urgency of the treatment. There’s no place for elitism in medicine and the medical fraternity in this country is disturbed by these developments,” the unnamed surgeon said.
The NZ Herald cited a leaked document outlining the Equity Adjustor that showed elderly Maori patients who had been waiting over a year for surgery jumping ahead of “a 36-year-old Middle Eastern patient who has been waiting almost two years.” This would appear to contradict official promises that the ethnic score would mostly be used as a tiebreaker for patients whose situations are similar in other respects.
New Zealand Prime Minister Chris Hipkins defended the ethnic adjustment system on Monday, but said he would ask Health Minister Ayesha Verrall to examine how the system is being implemented and investigate complaints of “racial discrimination.”
Hipkins, seemingly taken aback by the controversy over the new rules after media coverage sparked a public outcry over the weekend, complained that the system has unfairly been turned into a “political football.” Hipkins insisted it was still important to compensate for “systemic bias” in the health care system, but noted “concerns have been raised” about implementation.
New Zealand’s opposition parties came out strongly against the system, as the National Party pledged it would never “rank patients by ethnicity.”
“While there has been historical inequity that has disadvantaged Maori and Pasifika people, the idea that any government would deliberately rank ethnicities for priority for surgery is offensive, wrong and should halt immediately,” said National health spokesman Dr. Shane Reti.
“The way to improve Māori and Pasifika health is through better housing, education and addressing the cost of living, not by disadvantaging others,” Reti said.
ACT party leader David Seymour called the ethnic scoring system “indefensible” and said “racial discrimination is not needed” if the rest of the healthcare system is functioning properly.
“A person who is in great clinical need, has waited a long time, lives far from major medical facilities, and is poor could be Māori, European, Pacific, Indian or Chinese, and they should all be treated equally,” Seymour said.
“Racial discrimination has become the official policy of the New Zealand Government. Moving sick patients up and down health waitlists based on their race is fundamentally un-Kiwi,” he said.
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