Budget 2022: Government confident 'record' health spend will address inequities

Government ministers are hailing a "record" spend-up on health they say, over time, will address long-standing health inequities that see Māori die on average seven years younger.

But those involved in commissioning Māori health services are a little less enthusiastic, with specific funding for Māori making up just over 2 per cent of the total health spending.

Budget 2022 allocated $13.2 billion over the next four years to the health sector, which is undergoing massive transformation with the 20 DHBs shrinking into Health NZ, with the Māori Health Authority alongside it.

The funding includes $11.1b to cover cost pressures - essentially maintaining current spending with inflation - over the next four years, and cover an expected DHB deficit of about $550 million to give the new system a fresh start.

The total funding includes $188 million for the Māori Health Authority to commission services, and $102m over the next three years to provide better, earlier GP and community care and to ease pressure on hospitals.

Another $76m over the next four years will be spent to boost the primary healthcare workforce by the thousands.

Health Minister Andrew Little said providing multi-year funding certainty was designed to change up the old system, which saw the 20 DHBs run deficits in 12 of 13 years since 2008, racking up deficits of more than $3.5b.

This had seen them "eat into" money that should have been spent on maintaining and upgrading hospitals, he said.

From 2024, health budgets would move to a three-year cycle, he said. This was in line with the first three-year health plan, due in 2024.

Te Pāti Māori co-leader Rawiriti Waititi said Māori health allocations made up just 2 per cent of the health budget

"Based on that logic, it will take 1840 years to get to 20 per cent. Our whānau suffer from worse outcomes, we're dying seven to 10 years earlier than the general population. It's astounding to think the Government think this is suffice."

John Tamihire, CEO of Te Whanau o Waipareira which has been a key Māori health provider throughout the Covid-19 response, said such a small proportion of the overall health funding risked "building further inequality" in terms of services.

"But we are grateful overall to acknowledge a Māori delivery mechanism is being set up and supported. That is a win of significance for Māori."

Associate Health Minister (Māori) Peeni Henare said the funding today was on top of other funding already allocated, which amounted to about $1.2b over the next four years.

He also pointed out Māori would benefit from many other aspects of Health NZ. Another issue was having the services and workforce to commission in the first place, and Henare said that was where a $39m spend for Māori health workforce development would go.

"What Māori have always wanted is a health system that takes care of them and that meets their needs in a way that makes them feel comfortable, but that is not what our health system has delivered to date.

"Māori die at twice the rate as non-Māori from cardiovascular disease, Māori tamariki have a mortality rate one-and-a-half times the rate found in non-Māori children, Māori are more likely to be diagnosed and die from cancer, and Māori die on average seven years earlier than non-Māori.

"Māori deserve to live longer and healthier lives, and that is why this Government is reforming our healthcare system, and why we established a new Māori Health Authority as part of the reform."

The Māori Health Authority's direct commissioning budget has been allocated $33m in the coming year and another $45m the year after. The authority would get $168m in total over four years towards delivering hauora Māori services.

This included $68m for a blended te ao Māori population health and prevention programme, $26m for specific interventions for Māori whānau at different life stages, and $74m towards a programme to identify, uplift and develop mātauranga Māori.

Te Pāti Māori co-leader Rawiri Waititi. Photo / George Novak

A further $20.1m over four years will go to developing Iwi-Māori Partnership Board represented across the new healthcare system.

There was also $2.1b to be spent over the next four years on a range of different services, which included a $166m boost to ambulance services.

Other funding included $202m to mental health, $191m - across two years - for Pharmac, and $1.3b for capital upgrades (including priority services and hospitals).

The Budget also gives a $102m boost over three years for community healthcare to identify and treat issues earlier to prevent small issues from becoming big problems that could require hospital stays.

"This investment will grow primary healthcare teams around the country and allow GPs to work more seamlessly with services like physiotherapists, pharmacists and social workers to offer greater care, earlier, and closer to home," Little said.

GPs in high-needs areas are also being backed with $86m of new funding over four years so they can offer more care through improved opening hours and more appointments.

Little said he expected that funding to increase availability and decrease cost barriers.

People not going to GPs was a reason why many were turning up at emergency departments, he said.

Little said he expected costs for GP visits to drop, but that would be up to the health providers.