Ethnicity-based prioritization system stirs surgeons' disgust in Auckland, NZ

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Surgeons in Auckland, New Zealand are expressing disgust with a recent implemented policy that occurred in February. This policy mandates them to consider “historical disparities in healthcare access” for Māori and Pacific Island communities. These considerations will now play a role in a newly devised prioritization system for surgical procedures, leading to the surgeons' disgust.

As per leaked documents obtained by the NZ Herald, Te Whatu Ora – Health New Zealand has introduced a new initiative that utilizes an algorithm called the "Equity Adjustor Score." This algorithm takes into account factors such as clinical urgency, waitlist duration, geographic location, ethnicity, and level of deprivation to determine priority for individuals.

Patients belonging to Māori and Pasifika backgrounds are assigned higher rankings, whereas European New Zealanders and individuals from other ethnicities are given lower rankings.

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.”

The NZ Herald reports:

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.”

Health Minister Ayesha Verrall justified the decision by referring to a Government-commissioned review of the health system conducted in 2018. The review, conducted independently, highlighted the system's tendency to generate unequal outcomes, especially for vulnerable populations.

“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 renowned authority on Pasifika health, echoed the remarks of Verrall, emphasizing that Māori and Pasifika patients might be prioritized to receive medical attention ahead of others as a result of historical disparities.

"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."