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The main barriers to achieving equity were seen to be cost, cultural appropriateness in general practice, access to services and relationships with health professionals. One of the questions posed when conversing with the interviewees was regarding barriers faced by Māori when

accessing primary health care, which they agreed are an issue for Māori. In terms of cost and access a Māori Community Leader stated:

“There are barriers to Māori accessing health care, and that is no secret. Cost is a big one and the issue with our health care system is that you have private business with our GPs [General Practitioners], but they are also there to provide a service. You have a clash of ideologies really.”

Māori and Community Leader

Many interviewees expressed their concern with the ethical aspect of private businesses providing primary health care and had issue over the concept of paying to access services in primary health care. While the Aotearoa Government partly subsidises the cost of primary health care, the time restraints of consultation and associated costs, were viewed as being detrimental to access.

7.3.1

Funding

When undertaking the interviews many participants raised the issue with regard to funding. This section of inequity seeks to explore the concept of funding for WWRP. During the observations, many participants expressed that access to free health care through WWRP has improved how they access primary health care and the overall health of themselves and their

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consulting with health professionals, once they started engaging and accessing primary health care services, without cost as a barrier, the oranga of the whānau improved.

“From a whānau point of view and their engagement- loving it. I’m loving it, they’re loving that they can get access to their medical professionals and don’t have to worry about cost when they walk out. That’s great, but it is also about preparing them for the next stage when they leave the programme. How are they going to keep engaging? They won’t be able to engage at the higher levels that they are now. So that’s the challenge and it’s big huge juggling act.”

Senior Māori Advisor

The Senior Māori Advisor expressed a positive reflection on the WWRP participants accessing

free primary health care services for 12 months. Whilst this time allows participants to engage and access primary health care services, there is concern how they will continue to participate once they exit the programme. The Programme Staff Member interviewed expressed that she did not believe 12 months was a sufficient allocation of time to be beneficial to participants. By extending the programme a further six months, she believed the participants would gain a greater understanding of the health care system and would feel more comfortable and confident in continuing to engage and access services. However, while there is a desire to extend the length of the programme and the number of participants involved, limitations of funding constraints are the reality of this occurring.

“It frustrates me that funding follows the practices rather than the patients. I think it should follow patients and that would make a big difference, so programmes including WWRP and ‘Life Clinics’ would give us the opportunity to tailor our practice towards encouraging excellent services for high need populations. The reality is the funding is not enough from the government. I think it is really important for Māori to develop relationships and engagement.”

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The way funding is distributed for primary health care was discussed by many of the interviewees. It was expressed that within Aotearoa, the subsidised funding for patients enrolled with a Primary Health Organisation (PHO), is directed to the patients nominated General Practitioner (GP) within a general practice. This funding does not necessarily follow the patient if they relocate to a different general practice and many of the interviewees did not agree with this model.

A further question posed during the interviews was regarding the current Aotearoa health system and if it is providing accessible and affordable health care for Māori. It was stated by

some interviewees, that on the surface it appears that affordable health care has been achieved due to the government subsiding primary health care visits as well as some medications, however, all interviewees identified that affordable and accessible primary health care continues to be an issue for Māori. This is demonstrated in the quote below from the Senior

Māori Health Advisor.

“Currently there would be an argument that we are achieving universal health coverage. Would be great to have, it all looks great, but we are nowhere near that. I think it is applicable and for all government services to be talking together and planning with good consumer input. How are they actually implementing this?”

Senior Māori Advisor

The below quote demonstrates the frustration felt by individuals working within the health sector and the challenges faced when working in the current Aotearoa funding model. It was expressed that if Aotearoa wanted to achieve Sustainable Development Goal (SDG) 3, target 3.8, changes needed to occur in the health system especially in relation to primary health care funding. Conversations and debates regarding the cost of accessing primary health care could influence a change in how funding is delivered which may correlate in the reduction of inequity within the community.

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“No, not unless you have stroppy people in positions like me. If I look at the funding of Māori, Pacific and other low quintile people to health services, it is the practice that determines what and how they receive the money.”

Senior Māori Advisor

When discussing inequities in health with the interviewees it became apparent there was concern felt by all regarding affordability and accessibility for Māori. It was felt that a stronger targeted focused policy by the government on the implementation of SDG 3, target 3.8 would

be of value to achieve the improvement of health and wellbeing of Hawke’s Bay population.