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linw
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  #3092733 20-Jun-2023 17:46
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I have listened to Parliament and Heather's interview with the minister of health today.

 

Talk about incompetence from the government.

 

Some advice:- if you are bringing in a bomb and a match, don't apply the match to the bomb when all your party is surrounding it.

 

What a mess. Roll on the election.




sir1963
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  #3092736 20-Jun-2023 18:02
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Perhaps the correct way of saying this is the poor have not been well served by the health system and that Maori/Pacifica make up the majority of the poor.
In addition there will be cultural issues involved which will make various groups less likely to seek medical help.

 

Getting people involved in the health system through increased funding and encouragement as well as a better understanding of peoples cultural/religious/etc need/beliefs so they will feel more comfortable/able/trust/etc to use the health system is also important.
Having a wider range of ethnicities in our health system is incredibly important so patients know that their worldview is understood.

 

THEN comes "need" which should be blind to everything except the need of the patient, Then comes the ability of the system to service all the needs of the community.

 

 

 

 

gzt

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  #3092744 20-Jun-2023 18:57
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That's certainly one aspect. Removal of that $5 prescription charge was long overdue. Obviously it has to be paid for in tax and I'm happy with that. One consideration must have been the viability of smaller outlying pharmacies too. They were definitely under pressure from city competitors. As a windfall to a couple of large Australian owned chains it does grate. Hopefully it provides their young pharmacy workers with a good case for additional training and conditions anyway.



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  #3092749 20-Jun-2023 19:11
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Royal Australasian College of Surgeons backs equity policy:

NZHerald: The Royal Australasian College of Surgeons has spoken out about the new surgery wait-list rank system, explaining this isn’t about putting Māori and Pacific health above the health of other people, rather it’s about reducing existing health institutional bias.

ockel
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  #3092770 20-Jun-2023 19:58

gzt: Royal Australasian College of Surgeons backs equity policy:

NZHerald: The Royal Australasian College of Surgeons has spoken out about the new surgery wait-list rank system, explaining this isn’t about putting Māori and Pacific health above the health of other people, rather it’s about reducing existing health institutional bias.

 

"MacCormick made the point that Māori and Pacific patients are already over-represented in the portion of the new equity adjustor aimed to help the most, the so-called long waiters (those waiting more than 365 days for surgery)"

 

As I understand it then longer you wait on the list the greater your score in the criteria for waiting time and hence the higher your overall score.  But if you're already a long waiter then that implies, based on the calculation, that you should already be higher on the list.  Ergo Maori and Pasifika with the same clinical need should therefore, on average, be higher already.   I havent had it confirmed but I understand that it may be if you are in certain groups then the wait-time score grows faster for some ethnicities than others (something like 0.5/day for a European and 1.0/day for Maori/Pasifika.  This may be heresay. 

 

The biggest single issue is not the criteria but the lack of transparency on how the score is calculated.  Its a black box - a range of inputs, a magical algorithm and voila here is your score.  During the interview on Breakfast this morning it was put to one of the model designers that the NZ College of Surgeons wants to know how much weighting is put on ethnicity but the questions was avoided and described as an esoteric and intellectual question.  No-one is any the wiser after 2 days of debate.

 

Make a model open and transparent so every user (patient, GP and surgeon) can see how the score is calculated.  Black box models end up with $250m cost/benefit errors (a la Wellingtons speed limit reductions).  





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neb

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  #3092799 20-Jun-2023 21:18
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This would also appear to be in direct violation of the Declaration of Geneva, which is used by the World Medical Association in place of the somewhat vaguely-specified Hippocratic Oath:

 

 

 

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

 


 
 
 
 

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ezbee
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  #3092804 20-Jun-2023 21:57
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Has anyone anywhere shown they have real numbers that given equal rating on all other considerations, urgency of need, etc etc.
Is there any REAL data that non Māori are getting ahead in treatment ?

 

Māori may figure highly in certain categories, like Tongans might famously for certain conditions. 
But because there are more on the input side waiting does not mean they are being treated less.
Just there is not enough treatment capability for everyone.

 

Its just LAZY reading of headline numbers, without considering what they mean, what is happening in the process.

 

Problem has been misidentified, so the answer presented will not actually make a difference.


sir1963
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  #3092809 20-Jun-2023 22:24
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neb: This would also appear to be in direct violation of the Declaration of Geneva, which is used by the World Medical Association in place of the somewhat vaguely-specified Hippocratic Oath:
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

 

 

 

ROTFLMAO...it is done all the time.

 

Patients who do not pay their bills eventually get letters saying they are no longer patients at that practice.

 

Patients who are mentally ill/unstable who threaten and abuse staff will eventually get letters

 

Patients are left to die, we either don't have or can not afford the required treatments

 

We have cost benefit analysis going on, do we spent $100,000 to keep someone alive for another 12 months, or do we use that money to perform 5 hip operations that will dramatically improve those lives

 

Does that oath allow them to force treatment onto patients ?

 

But the reality is also that cultural and a whole pile of other factors can sometimes make useful communication and understanding between the health system and patients difficult. Does the doctor take that as being the patient refusing what they consider sensible treatment ?

 

A good example of this is people with head injuries are typically loaded into an ambulance feet first, they can control the acceleration, but they may have to brake severely to avoid an accident. Blood rushing to the feet vs the head has different outcomes. Simple, Logical...right ?, But then there is the belief that dead people are carried feet first , so of you try and put some patients feet first into an ambulance you are telling family and the patients they will die. To them it can even look as though their loved one will not be treated as they have already been written off.

 

People get so wrapped up in their idea of normal, they can not understand why others disagree.

 

For example, it is common to swear an oath on the bible, but what do you do in a country that has a state religion, eg Islam, do you swear an oath on the Koran ?

 

An Atheist would chose to make an affirmation as they do not see the sense of swearing an oath to a non existent being.

 

 

 

People are wilfully ignorant of the issues other cultures have that disables them from engaging properly, we blame them, it their fault, and if we happen to benefit from that, so much the better.

 

What protests were made about that ?, none, the majority were comfortable.

 

I was the custodial parent, but WINZ "preferred to deal with the mother" when it came to my disabled son. I fought that one because I don't do that kind of BS, others who have been knocked back all their lives would have just walked away.

 

I get to see medical, jobs, public reaction, etc etc  situations for my son. THAT is not great either, he gets dismissed all the time, another situation I will not tolerate. People feel entitled to abuse him, I have even heard "They don't understand so who cares"....yep people are that sh!t

 

 

 

My Step kids are Samoan, we had neighbours coming over questioning why their friends were in the neighbourhood when they came to visit, "Why are you here ?, Are you expected ?, Who are you seeing?", the kids were called Maori all of the time. My response to that casual racism usually involved their sticking their heads in places where the sun don't shine and made me few friends.

 

 

 

When the wife and I were last in Hong Kong, we regularly had shop keepers follow us around the store, not to sell us anything, but to make sure we did not steal anything, we told the kids when we got back to NZ and they just laughed and said that was normal for them.

 

So yes, there can be good reasons why some bias is needed short term to try and rearrange the balance that should already be there naturally but is not in reality. The time most people REALLY hate discrimination /bias/etc is when its against them, but remain casually dismissive when its against someone else.

 

 

 

 


Bluntj
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  #3092812 20-Jun-2023 22:30
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sir1963: Perhaps the correct way of saying this is the poor have not been well served by the health system and that Maori/Pacifica make up the majority of the poor.
In addition there will be cultural issues involved which will make various groups less likely to seek medical help. Getting people involved in the health system through increased funding and encouragement as well as a better understanding of peoples cultural/religious/etc need/beliefs so they will feel more comfortable/able/trust/etc to use the health system is also important.
Having a wider range of ethnicities in our health system is incredibly important so patients know that their worldview is understood. THEN comes "need" which should be blind to everything except the need of the patient, Then comes the ability of the system to service all the needs of the community.    

 

 

 

You are far from correct in this assumption. I believe white NZers make up by far the poorest group. However, Maori and Pacific Islanders are overrepresented to quite a large degree.


GV27
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  #3092827 21-Jun-2023 05:58
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But you can't address issues where people won't seek medical help with elective surgical waiting lists. That doesn't get anyone onto a waiting list any faster. Those people have already sought medical help. You don't just wake up and find you have an elective slot for something without a degree of engagement and referral first.

 

It seems eminently confused about the actual issue it's trying to address.


Paul1977
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  #3093471 22-Jun-2023 15:04
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I read one argument for the change saying that because Māori and Pasifika were poorly serviced by primary care physicians it often takes them longer to get the referral they need, so by the time they are on the waiting list they have been "waiting" a long time already.

 

It's the best argument I've heard in support of the policy, but still fails in one very obvious way: Not every Maori or Pasifika patient was improperly delayed in getting on a waiting list, and conversely not every non-Māori or non-Pasifika patient gets straight on.

 

But if this is a concern, then simply backdate the waiting list "start date" to when the the patient first presented with the issue to their primary care physician. Do this across the board for everyone.


 
 
 

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ockel
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  #3093571 22-Jun-2023 16:34

Paul1977:

 

I read one argument for the change saying that because Māori and Pasifika were poorly serviced by primary care physicians it often takes them longer to get the referral they need, so by the time they are on the waiting list they have been "waiting" a long time already.

 

It's the best argument I've heard in support of the policy, but still fails in one very obvious way: Not every Maori or Pasifika patient was improperly delayed in getting on a waiting list, and conversely not every non-Māori or non-Pasifika patient gets straight on.

 

But if this is a concern, then simply backdate the waiting list "start date" to when the the patient first presented with the issue to their primary care physician. Do this across the board for everyone.

 

 

Primary care capitation rates differ depending on ethnicity, deprivation, rural and/or whether you hold a community services card.  It doesnt lend itself to solving the "poorly serviced by primary care physicians" issue.  Nor their referral - if a GP knows that someone is going to get deprioritized on the waiting list because they smoke or have a BMI that falls outside the surgical guidelines then the GP wont bother with a referral.  Thats not poorly served, thats understanding that referring someone that you know will get rejected or bumped down the list is going to happen regardless of their ethnicity.  





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gzt

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  #3093683 22-Jun-2023 19:36
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ockel: - if a GP knows that someone is going to get deprioritized on the waiting list because they smoke or have a BMI that falls outside the surgical guidelines then the GP wont bother with a referral. Thats not poorly served, thats understanding that referring someone that you know will get rejected or bumped down the list is going to happen regardless of their ethnicity.

You have too many hypotheticals but anyway.. I'm not convinced that all GPs are genuinely familiar with public surgical criteria in use at any one time. That being the case a 'non-referral' in error may occur purely on that basis or similar incorrect assumptions.

ezbee
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  #3094111 23-Jun-2023 14:23
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Patents reluctance to accept a referral may also be a factor along with ability to qualify.
How GP's and specialists deal with each other, if you refer more than what specialist has resources to deal with ?

 

Another one may be the population mix of particular Hospital areas, and the resource that area gets to deliver on the demands it has.
So problem may be geopgraphic not raceographic.

 

If any experience I have had of Auckland Hospital vs Middlemore are anything to go by.

 

These and other factors should be looked at rather than presumption of deliberate bias. 
Fix the problem at the start by finding out the root causes and seeing what you can do to deal with them. 

 

Its easy to blame race when its probably a bunch of other factors that need different solutions.


gzt

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  #3094199 23-Jun-2023 18:08
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ezbee: These and other factors should be looked at rather than presumption of deliberate bias. Fix the problem at the start by finding out the root causes and seeing what you can do to deal with them.

I think you're wrong about that assumption. I'm not aware of any evidence of a presumption of deliberate bias.

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