Māori and Pacific patients could be prioritised for some elective surgeries and appointments as DHBs look to reshape a health system emerging from lockdown.
As alert level 2 nears, Auckland, Waitematā, Counties Manukau and Northland DHBs are preparing to tackle waiting lists lengthened by the postponement of procedures, and identify people with the highest clinical need.
"These are frequently Māori and Pacific peoples and they are also often the first to miss out at times of high demand or when there are other barriers to healthcare," a spokeswoman for the DHBs said.
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People accepted for treatment are often given a priority ranking. For example, priority one patients are considered urgent and might be seen within two weeks, priority two may be seen within six to eight weeks, and priority three and non-urgent cases face a wait of months.
One option that's been discussed is bumping Māori and Pacific patients up a priority band in certain instances, the Weekend Herald understands. Another might be making Māori and Pacific ethnicity a factor when working out a priority rating score.
A spokeswoman for the northern region DHBs did not directly answer questions about whether those or similar changes were being considered.
DHBs were at different stages in the wider prioritisation work, she said, and solutions could vary.
"The planning process will be data and evidence-based and in some DHBs will include clinical technical advisory groups. Further details will be available in the future as work develops.
"We are committed to working together to deliver better health outcomes for Māori and Pacific people and as a result improve the health of our whole community."
DHBs operate with limited resources and most are in deficit, but one clinician said any changes would be designed so other patients weren't disadvantaged.
"The aim is to try to rectify under-treatment and lack of access for Māori and Pacific patients who are significantly under-treated for many reasons across all sorts of health care, and this is one tool we are looking at."
Dr David Tipene-Leach, chair of Te Ora, the Māori Medical Practitioners Association, said the northern region DHBs had in the past 18 months rolled out a suite of projects focused on equity.
"What you have in Auckland is a group of widely thinking health leaders who are trying to solve the equity problems in their region ... there's so much reformulating of the way things are going to be working in the post-Covid period, this is the time to really address inequity."
Using ethnicity to help prioritise patients was justified given "terrible" health inequities, Tipene-Leach said. However, factoring in deprivation could make the reforms more palatable to some New Zealanders.
"People who live in decile 9, 10 communities [the most socioeconomically deprived] also have inequitable health outcomes. There is this aphorism in the Māori health field - if you get it right for Māori, you get it right for everybody."
Dr Rawiri Jansen, co-leader of Te Rōpū Whakakaupapa Urutā, a national pandemic group formed by Māori medical and health experts, said it would be "extremely negligent" if DHBs returned to a business-as-usual approach.
"Taking an evidence-based approach to the resumption of services is necessary, and wherever required, Māori access to diagnosis and treatment prioritised to ensure that the backlog of treatment does not see Māori at the bottom of the list."
Under level 4 restrictions, most electives (medical or surgical services that aren't required immediately) were postponed, as hospitals diverted resources and capacity to prepare for any surge in Covid-19 patients.
The aim is to clear backlogs in an 18-month recovery period that will take full effect once the country returns to level 2, level 1 and normal status.
A number of studies and reports show Māori and Pacific people are less likely to be referred or accepted for treatment in the first place, and once in the system generally get less treatment.
Auckland DHB has attributed part of the problem to institutional racism, which is a term that describes how procedures or practices result in some groups being disadvantaged.
Last year a landmark report by the Health Quality & Safety Commission challenged health services to stamp out institutional racism it says severely harms and kills Māori.
Its review gave a range of examples, including that specialist appointments have unacceptably long wait times and happen less often for Māori, who were also less likely to get certain treatment soon after admission. Pacific and Māori patients consistently rate the communication with hospital staff and doctors lower than other groups.
The commission's chairman, Professor Alan Merry, said of the report that, while broader social factors influence a person's health, the findings suggested seeking healthcare doesn't reduce inequities: "In fact, the results suggest the health system creates further disadvantage for Māori."
A special edition of the NZ Medical Journal recently highlighted the fact half of Māori and Pacific deaths in New Zealand are potentially avoidable, compared to 23 per cent for non-Māori and non-Pacific people - saying this was a "travesty and a lost opportunity within families, communities and Aotearoa".