Surgery / Mental heathcare based on skin colour

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Forums › Politics › Surgery / Mental heathcare based on skin colour

surfisup1000

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#305994 19-Jun-2023 11:11

https://www.nzherald.co.nz/nz/auckland-surgeons-must-now-consider-ethnicity-in-prioritising-patients-for-operations-some-are-not-happy/ONGOC263IFCF3LADSRR6VTGQWE/

Interesting policy. I'd be concerned if I were on a waiting list.

Too bad if you're white, chinese, indian, etc . This appears to be in Auckland for now, but they are rolling it out to other areas.

The DHB will also never tell you how far you're being bumped down the list, you'll just be on the list for a lot longer .

Also, the 4 free mental health counselling sessions are no longer available to non-maori. One mental health counsellor said on the radio this morning that Maori often did not turn up to counselling appointments and she would not get paid . At the very least, the government should cover her for non-shows.

I see the main benefactors of this policy as being educated maori, who tend to be equivalent or better off in health and income to their non-maori counterparts.

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#3091964 19-Jun-2023 12:33

Another case of trying to make two wrongs to make a right?

Difficult to debate the merits of the policy without a decent working knowledge on both the healthcare system along with the data on which the decision has been made. It also states that it is only 1 of the determining factors in a decision, I would certainly hope that medical need is prioritised against all other factors and if there are two that are on the waiting list with the same medical need, the treatment goes to the one that has been waiting the longest.

GV27

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#3091968 19-Jun-2023 12:50

You improve medical outcomes by making treatments to everyone on the basis of medical need, not changing the definition of 'need'.

Technofreak

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#3091970 19-Jun-2023 12:58

Since when does two wrongs make a right?

Fix the root cause problem don't inflict a wrong on everyone in an abortive attempt to fix a problem.

This stupid idea only benefits those needed surgery. What about all those not needing surgery but still missing out?

The Health Minister should be all over this and be quashing such silly ideas.

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Paul1977

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#3091971 19-Jun-2023 13:00

Ethnicity shouldn't be a direct determining factor at all.

Ethnicity should only be considered if medically relevant. E.g. if evidence shows that Maori or Pasifika suffering from a certain condition deteriorate more rapidly without intervention, then there are medical grounds why they should be given priority. That's as it should be. But that's not what this policy is saying.

Several surgeons say they are upset by the policy, which was introduced in Auckland in February and gave priority to Māori and Pacific Island patients - on the grounds that they have historically had unequal access to healthcare.

This is absolutely a case of battling historical inequality with present day inequality.

gzt

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#3091977 19-Jun-2023 13:07

First let's be 100% clear. The criteria does not involve skin colour at all. Ethnicity is the word you might be looking for.

Also, you have provided no link for your mental health claim. The link covers only bariatric surgery.

Paul1977

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#3091983 19-Jun-2023 13:15

gzt: First let's be 100% clear. The criteria does not involve skin colour at all. Ethnicity is the word you might be looking for.

Also, you have provided no link for your mental health claim. The link covers only bariatric surgery.

Colloquially "skin colour" and "ethnicity" are often used rather interchangeably (I'm not condoning, just stating a fact). The OPs use of the term "skin colour" does somewhat sensationalise the topic (and probably isn't what I would have used), but I don't see that it changes the substance of the argument.

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gzt

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#3091985 19-Jun-2023 13:23

The link provided discusses bariatric surgery. There have been several if not numerous studies showing Maori suffer inequitable treatment at primary care level. Mostly GP. For instance, a belief that Maori patients are less likely to take prescribed medication, therefore less medication is prescribed, in turn meaning less requirements for surgical referral are met, in turn leading to less surgery. Ie; cascade starting at primary care.

The surgical criteria change is an attempt to address these statistics. I'm not aware of other non-medical criteria used in surgical assessment. I'd be interested to know. I have definitely have some sympathy for surgeons being asked to use non-medical criteria to compensate for issues at primary and secondary care level.

It seems to me this approach has been taken in an attempt to reduce horrible, unacceptable and documented inequities. Which it probably will, at least to a small extent.

Paul1977

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#3091991 19-Jun-2023 13:31

gzt: The link provided discusses bariatric surgery. There have been several if not numerous studies showing Maori suffer inequitable treatment at primary care level. Mostly GP. For instance, a belief that Maori patients are less likely to take prescribed medication, therefore less medication is prescribed, in turn meaning less requirements for surgical referral are met, in turn leading to less surgery. Ie; cascade starting at primary care.

The surgical criteria change is an attempt to address these statistics. I'm not aware of other non-medical criteria used in surgical assessment. I'd be interested to know. I have definitely have some sympathy for surgeons being asked to use non-medical criteria to compensate for issues at primary and secondary care level.

It seems to me this approach has been taken in an attempt to reduce horrible, unacceptable and documented inequities. Which it probably will, at least to a small extent.

The article uses bariatric surgery as one example, but my understanding is this policy applies to all types of care.

If problems are happening at the primary care level leading to inequitable outcomes, then they need to be addressed at the primary care level. This policy won't do anything about that.

ezbee

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#3091995 19-Jun-2023 13:40

Its not so much the basing things on historical statistics.
So much as really looking to see what is behind the statistics at a deeper level.
Auto assuming discrimination is lazy.

Already there was a comment with free mental health visits that certain ethnicities don't turn up.
So the ones that do turn up seem to be getting unfair proportion of care when its not the case.
Discrimination against those who need mental health care and willing to take treatment, so they won't get it is not the way.

There will be similar stories buried in the detail, that will reveal better ways to get a better result.
Without a kind of apartheid.

For organ transplants races x and y don't tend to donate organs, so we have less to match which has been reported as well ?
You then get problem of people turning up too late and an operation would be a large resource with little chance of positive outcome.

Dealing with why they don't have a family doctor, and don't turn up earlier is better than shuffling the operation priority.
Why the screening programs are not getting to them, or lack of screening programs at all.

wellygary

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#3092001 19-Jun-2023 13:56

Waiting for the Sausage-roller in Chief to either chain his political career to it at the post Cabinet press conference this afternoon, or to carefully shoot political holes in it...

Also hoping the news shows tonight decide to go for a "two-fer" and seek our Race relations commissioner Meng Foon's comments on the policy :)

surfisup1000

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#3092010 19-Jun-2023 14:19

gzt: First let's be 100% clear. The criteria does not involve skin colour at all. Ethnicity is the word you might be looking for.

Also, you have provided no link for your mental health claim. The link covers only bariatric surgery.

An email was sent to mental health counsellors in May to notify them of the changes to the four free mental health sessions. Only young people and Maori now qualify for the free sessions. You can listen to this mornings Newstalk ZB if you like. This government is reticent to advertise such changes.

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cruxis

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#3092108 19-Jun-2023 16:34

It coming to the point it might be best to tick the top 4 ethnicity boxes on most forms now. If you are having a newborn tick the Maori, Pacific, Asian and European boxes when getting the birth registered. Just in case your child gets put on a waiting list in the future.😏

gzt

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#3092195 19-Jun-2023 19:23

surfisup1000: An email was sent to mental health counsellors in May to notify them of the changes to the four free mental health sessions. Only young people and Maori now qualify for the free sessions. You can listen to this mornings Newstalk ZB if you like. This government is reticent to advertise such changes.

I've listened to a few items now since your post and still have not found that one. Funny thing along the way, Barry Soper saying he'd written the story without any input from ACT whatsoever and Seymour was trying to say ACT was the source. By the by.

As for the government being reticent I'm thinking NZ government of any stripe does not typically gazette surgical criteria and the like. This one seems like something where the minister has said "fix these terrible stats" and this is what the ministry has come up with.

Bluntj

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#3092311 19-Jun-2023 21:48

Even the bariatric surgeon isn't happy. I thought the reason we had a separate Maori health system was to address these needs. Seems to me to be more interference by politicians who have their own agenda.

GV27

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#3092333 20-Jun-2023 07:00

Paul1977:

If problems are happening at the primary care level leading to inequitable outcomes, then they need to be addressed at the primary care level. This policy won't do anything about that.

+100. If you are getting to the point where clinical need like surgery is being allocated based on ethnicity it suggests there's been total entrenched failure at every step up until that point and there are other questions that should be asked i.e. really, how effective is the army of non-clinical staff health ministries and boards have accumulated over the years if all they have done is entrench existing systematic equality? There is a degree of trusting the people and systems that got us into this mess with getting us out of it.

Administrators should not be overriding the wishes of practitioners and surgeons, who have an ethical obligation to not engage in anything that does additional harm to patients. Making another patient wait longer due to their ethnic background despite both having the same clinical need for health services is flat-out wrong, and I suspect some doctors would argue that violates that principle.

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