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RNZ News
7 days ago
- Health
- RNZ News
GP funding changes will worsen Māori health inequities, expert says
The GP funding changes are proposed to take effect from 1 July 2026. Photo: RNZ A public health expert says the government's updated funding formula for general practices will fail to address the country's biggest health inequities because it excludes ethnicity. From July 2026, GP clinics will receive funding based on factors such as age, sex, rurality, socioeconomic deprivation and morbidity. The changes are intended to replace a 20-year-old model that largely used age and sex to determine funding levels. But public health senior research fellow at Otago University Dr Gabrielle McDonald said the government had ignored expert advice to also include ethnicity, despite strong evidence it was a powerful indicator of health need. "It's illogical," she told RNZ. "Leaving ethnicity out means [funding is] not going to be allocated to those highest areas of need, which will make accessing health care more difficult for Māori and Pacific communities." McDonald said data showed Māori lived seven years less than non-Māori and had higher rates of many serious illnesses, including cancer, even when poverty and other social factors were taken into account. "There's a lot of data that shows Māori don't get as good a deal from the health system as non-Māori. We've got a system that doesn't respond to Māori and Pacific people, it's geared towards the so-called majority Pākehā," she said. The funding formula is used to allocate money to general practices based on the characteristics of their enrolled patients. A 2022 government commissioned analysis by consultancy Sapere recommended it should include age, sex, ethnicity, deprivation, morbidity and rurality. "It was very thorough and they produced a high-quality report and put ethnicity in the funding formula because there was evidence to support that. "And so the government has said, yes, that's good, we will use that formula, but they've taken the ethnicity out, which is illogical," McDonald said. McDonald said removing ethnicity would make it harder to reduce inequities in primary care, which acted as the "gatekeeper" to the rest of the health system. "We know that general practices are the backbone of any good public health service. "Measures that don't aim to reduce inequities at that spot mean you're going to be playing catch-up throughout the health system if you can't reduce inequities in accessing primary care." She said including ethnicity was "highly justified." "We know our health dollar is really scarce and it needs to be spent where it's most needed. Leaving ethnicity out means it's not going to be allocated to those highest areas of need, which will make accessing health care more difficult for Māori and Pacific communities." McDonald has been a public health physician since 2011 and is a Pākehā researcher at Kōhātū - the Centre for Hauora Māori at the University of Otago. She has worked as a doctor for about 25 years, including extensive experience reviewing child and adolescent deaths. "I've spent a large amount of time reviewing child and adolescent deaths, and the inequity is very, very obvious there," she said. "Māori and Pacific children bear the brunt of many of the negatives of living in our society and they pay for it with their lives. We've got inequity in death rates for children and adolescents in almost all areas." Minister of Health Simeon Brown says Māori and Pacific peoples, in particular, will benefit from the updated GP funding model. Photo: RNZ / REECE BAKER In a statement to RNZ Minister of Health Simeon Brown said too many Kiwis were waiting too long for a GP appointment. "The current funding model is outdated and doesn't fully reflect the needs of patients," he said. "That's why we're making changes to the way GP clinics are funded to ensure money goes where it's needed most, with the revised formula going beyond age and sex to also factor in rurality, multimorbidity and socioeconomic deprivation." GP clinics serving communities with higher health needs would receive more funding to care for their patients, he said. "The reweighted formula recognises the impact that age, rurality, complexity and deprivation have on health outcomes, and will ensure resources are targeted to those with the greatest need. "Māori and Pacific peoples, in particular, will benefit from this change." The changes are proposed to take effect from 1 July 2026. Public health physician and Otago University research fellow Dr Gabriel McDonald says data shows Māori often face extra hurdles getting the right care and the same treatment as non-Māori, even when poverty is factored in. Photo: Supplied / Gabrielle McDonald However, McDonald said she expected the government to implement a "state-of-the-art, fully fit-for-purpose formula," but that the final version "ignored the ethnicity funding factor". "We know from the data that outcomes are not the same for Māori and non-Māori, even when you take into account poverty and other factors. "Māori face additional barriers to accessing care, to accessing appropriate care, and to receiving the same level of treatment once they do access care. There's a lot of data showing Māori don't get as good a deal from the health system as non-Māori." "And then there are the determinants of health, things like poverty, level of education and other factors, which we know are not equally distributed, with Māori marginalised in almost every area." She also believed the decision reflected a wider trend in government policy. "There's a lot of pushback to talking about the needs of ethnic groups, even where there's really good reason to pay attention to ethnicity." She argued the government should adopt a complete, evidence-based mechanism for funding general practices, rather than the partial formula announced, to align with its stated goal of needs-based funding. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
The Independent
20-06-2025
- Business
- The Independent
Why is Angela Rayner shifting the council tax burden from north to south?
When Angela Rayner took over her department, the first thing she did was to delete 'levelling up' from its name. But she insisted that she was committed to the idea behind the phrase, and now she is about to announce a change in local government funding to prove it. The new funding formula is expected to allocate money from central government according to local needs, including population, poverty and age, with extra weighting for rural and coastal areas with higher transport costs. The effect will be to force local councils in London and the home counties to put up council tax. Many of them are expected to increase tax by the maximum 5 per cent a year for several years, and more than before will ask Rayner for permission to hold a local referendum on an increase greater than 5 per cent. Councils in the north, the Midlands and east London, on the other hand, may be able to cut their council tax, or at least increase it by less. Is this fair? Labour argues that the Conservatives have fiddled the funding formula for 14 years, resulting in artificially low council taxes in places such as Westminster and Wandsworth – former Tory councils that attracted disproportionate media coverage in local elections. In the end, this attempt to cook the books could not hold back the electoral tide, and Labour won control of both councils in 2022. Clobbering those councils is going to make it harder for Labour to retain control, so it could be argued that Rayner is motivated purely by wanting to rebalance the national distribution of resources according to need. The new system will probably be fairer than the current one, if not perfectly fair, but any attempt to adjust local government funding throws up winners and losers – and the losers always make more noise than those who quietly pocket their gains. How quickly will the change happen? Even if the change were totally fair in principle, any sharp fall in central government funding and big increase in council tax is likely to cause hardship. That is why Rayner is expected to adjust her new formula by putting a limit on how much any council's income from central government can fall in a year. David Phillips, of the Institute for Fiscal Studies, says: 'It's been 20 years since we've had an effective system to allocate funding between councils so it is out of whack and the changes are going to be big.' That means any changes will probably be phased in over several years. What could possibly go wrong? If Rayner delivers a funding system for local government that is more closely aligned with local needs, she could deliver more radical policy substance than the Conservative slogan of 'levelling up' ever managed. But Phillips points out a philosophical problem. The more the government tries to redistribute resources from 'leafier places' to deprived areas, the more 'it is making a trade-off to prioritise need over incentives for councils to tackle need and grow their council tax base', he says. If councils receive more funding the higher their indicators of deprivation are, there is a danger of perverse incentives for them to keep those indicators high. Shouldn't council tax be revalued from scratch? Of course it should. It is based on notional property values in 1991 (in England; in Wales the reference date is 2003), so it is hopelessly out of date. But revaluation would produce even more dramatic individual winners and losers than changing funding for whole council areas. Rayner's redistribution is already what Sir Humphrey would describe as 'very brave, deputy prime minister'; a full revaluation would be several times braver – in other words, a guaranteed political disaster. The most that is likely to be politically feasible would be to revalue council tax for more expensive properties, such as the one in 20 UK homes currently on the market for more than £1m. A similar policy, called a mansion tax, was considered by the coalition government – George Osborne and the Liberal Democrats wanted it but David Cameron vetoed the idea, saying the Tory party's donors wouldn't wear it. Given that Rachel Reeves, the chancellor, is likely to be looking for new sources of revenue in the autumn Budget, this may be an option. She did rule out a mansion tax before the election, but I don't think it has been mentioned since. Look out for even greater 'fairness'.
