New ranking system prioritising patients on ethnicity to improve equity, experts say

Auckland’s surgeons are using a new method to prioritise patients – and health experts say it is improving surgical wait list inequities.

Alongside other factors, the tool uses an algorithm to rank patients on the basis of ethnicity, geographical location and clinical priority.

The equity adjuster tool introduced in February this year is live across all surgical services at Te Whatu Ora Te Toka Tumai Auckland, including at Starship Children’s Hospital and some other northern region areas.

Te Whatu Ora interim lead for Te Toka Tumai Auckland Dr Mike Shepherd said one contribution to reducing inequity was the application of targeted equity adjusters.

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“People waiting on wait lists for treatment were prioritised by a combination of clinical urgency and the length of time on the waiting list. However, we know that using this method alone disadvantages people who have a longer pathway to get on to a waiting list in our current system.

“These adjustments are based on evidence which shows these groups often have inequitable health outcomes which often begin at the start of their healthcare journey. Clinical teams work in close collaboration to implement the adjuster, with clinicians making the ultimate decision about the wait list.”

New Zealand Society of Anaesthetists’ president Dr Morgan Edwards said many Māori patients were likely to have experienced health inequalities before even reaching surgical wait list.

“This is an attempt to try and achieve more equity, rather than give any advantages.

“At a basic fundamental level, when a Māori patient hits that surgical wait list they’re already far behind their non-Māori counterparts. This is a small step to address that inequity.”

The tool provides an Equity Adjuster Score, aiming to bring down inequities in the system to prioritise patients according to five areas – clinical priority, time spent on the wait list, geographic location (isolated areas), ethnicity and deprivation level.

The ranking system has received backlash from many people who say it gives priority to Māori and Pacific Island patients, while European New Zealanders and other ethnicities, like Indian and Chinese, are lower-ranked.

ACT Leader David Seymour said using ethnicity to prioritise healthcare wait lists was lazy and divisive, and “it’s not who we are as a country.”

“People who have less need are leapfrogging those who have more need. That’s completely wrong, and it’s got to stop.”

“A person who is in great clinical need, has waited a long time, lives far from major medical facilities, and is poor could be Māori, European, Pacific, Indian or Chinese, and they should all be treated equally.”

Dr Shepherd said the Covid-19 pandemic had a negative impact on equity globally, so it is hugely beneficial to have this equity adjuster to help address the problem.

Research published in January showed health inequities for Māori children cost society more than $170 million while the government actually saves money.

In 2019, the Waitangi Tribunal, backed by evidence and consensus from witnesses, raised concerns and determined that institutional racism and individual racism exists in the health system.