15 September 2023
Y C Cheng
[FYI request #23185 email]
Tēnā koe YC Cheng
Your request for Official Information, reference: HNZ00022786
Thank you for your email of 20 June 2023, asking for the following which
has been considered under the Official Information Act 1982 (the Act):
Could you please advise the full/complete algorithm used for the Equity Adjuster Score,
which prioritises "patients according to five areas; clinical priority, time spent on the
waitlist, geographic location (isolated areas), ethnicity (specifically Māori or Pacific
people) and deprivation level.
Response
We have published this information: See the documents here: https://
www.tewhatuora.govt.nz/publications/equity-adjustor-tool/
We are therefore refusing your request under section 18(d) of the Official Information Act on the
basis that the information is or wil soon be publicly available.
Context for our work to pursue health equity
Work developing the tool to reduce inequity in access to planned care surgical services in
Auckland and some other parts of the Northern region was substantively undertaken before Te
Whatu Ora came into existence. It now sits within the context of the health reforms, and the
requirement under the Pae Ora (Healthy Futures) Act that we actively pursue health equity.
While equity is a particularly important concept in the health system – because all groups of people
care about their health – understanding and meeting the needs of different communities and
groups of people is a familiar challenge for organisations in all kinds of settings. This includes
understanding why services do or don’t work for some groups, what barriers prevent positive
outcomes (including how services are delivered), and how best to identify people who may need
something different.
Similarly, our legislation requires us to design, arrange and deliver services that achieve the Act’s
purpose, including to ‘achieve equity in health outcomes among New Zealand’s population groups,
including by striving to eliminate health disparities, in particular for Māori’. Furthermore, Te Whatu
Ora is required to act in accordance with the ‘health sector principles’, the first of which is that ‘the
health sector should be equitable, which includes ensuring Māori and other population groups:
(i)
have access to services in proportion to their health needs; and
(ii)
receive equitable levels of service; and
(iii)
achieve equitable health outcomes.
These expectations of our work, set by Parliament, are very clear, underpinning the very important
work we are required to do to achieve health equity.
link to page 2
Evidence of health inequities
The requirements and expectations noted above are not surprising when considering key health
statistics, which show some groups of people – particularly Māori, Pacific, people with disabilities
and those from high deprivation and rural areas – are not doing as well as others. Large
differences exist in health outcomes, including life expectancy. We note:
•
for evidence and data regarding people’s health, health equity and inequity at a national
level see the Health Quality and Safety Commission’s (HQSC) A Window on the Quality of
Aotearoa New Zealand’s Health 2019 –
https://www.hqsc.govt.nz/resources/resource-
library/a-window-on-the-quality-of-aotearoa-new-zealands-health-care-2019-a-view-on-
maori-health-equity-2/ &
•
for evidence and data on the impact on health equity of where New Zealanders live see the
Geographic Classification for Health –
https:/ journal.nzma.org.nz/journal-articles/defining-
rural-in-aotearoa-new-zealand-a-novel-geographic-classification-for-health-purposes
With respect to ethnicity, including its consideration as a prioritisation factor, it is important to note
that there remain significant dif erences in a range of health indicators – by ethnicity – even when
other factors like socioeconomic status, rurality or gender are taken into account. For example,
Māori living in the most wealthy (least deprived) areas stil have a life expectancy gap of more than
6 years when compared with non-Māori-non-Pacific people living in the same areas (it is also the
same gap seen in the most deprived areas). Similarly, for Māori living in urban areas, there is also
a life expectancy gap of more than 6 years compared to non-Māori-non-Pacific urban populations
(and the same gap is also seen in the most rural areas).
In other words, neither rurality nor deprivation level alone explain significant health inequities for
Māori. We also know that the causes of health inequity are complex and require diverse responses
and solutions embedded across the health system. One way to reduce inequity is the subject of
this letter: the application of criteria or tools that prioritise service delivery, with the aim of improving
the equity of health outcomes.
Comments on the Equity Adjustor Tool
Ultimately, when it comes to non-urgent care, the health system aims to treat people in a timely
way and not have them waiting longer than 4 months. Prioritisation, though, is an important tool for
managing the delivery of health services within our resources.
Prior to the establishment of Te Whatu Ora, work was undertaken over many years by District
Health Board (DHB) staff in the Auckland area to examine tools and approaches to reduce
inequities in health outcomes. This work led to the development of an Equity Adjustor Tool, which
takes several factors into account to help prioritise non-acute care (noting also that non-acute care
excludes cancer treatment, which is not subject to the adjustor tool).
Patients are first prioritised according to their clinical need and placed into a clinical category. The
equity tool is then used to help determine the order in which patients are booked for surgery within
each clinical category. Factors taken into consideration include the length of time someone has
been waiting, Māori or Pacific ethnicity, patients from low socio-economic areas and those living in
rural areas.
Like all prioritisation tools, we keep learning more as we go, which helps us improve and achieve
better and more equitable health outcomes.
1 In that regard, it’s important to note that some options
and design features mentioned in the documents released to you are not part of how the current
Equity Adjustor Tool is applied. For example, before the tool was adopted, for a short period
1 The implementation framework for this work in Auckland is included in the Te Whatu Ora | Health New Zealand’s
Planned Care Taskforce Reset and Restore Plan. This plan can be found at:
https://www.tewhatuora.govt.nz/publications/planned-care-taskforce-reset-and-restore-plan/
Māori and Pacific were moved up a clinical category for some services, with the intention of
addressing a disproportionate impact in wait times due to COVID-19 pressures. During the
development work, there was also consideration of whether expectations embodied in Te Tiriti
should be reflected through an additional prioritisation factor; this was not implemented
(recognising also the significance of the ethnicity criteria for Māori). When the tool was
implemented, there may also have been a small number of cases early in its application where the
tool resulted in patients being effectively shifted between clinical priority categories (not intended
by the tool); checks and balances are now in place to prevent this from occurring.
Given the ongoing importance of our work to achieve health equity, we are conducting an
evaluation of the tool and we have paused any further roll-out until this has been completed. This
wil enable us to better understand how the tool has been used and monitored, the impact the tool
is having, identify what other approaches are being used in other areas, as well as inform our
pursuit of health equity for all groups of people.
If you have any questions, you can contact us at
[Health New Zealand request email].
If you are not happy with this response, you have the right to make a complaint to the
Ombudsman. Information about how to do this is available at
www.ombudsman.parliament.nz
or by phoning 0800 802 602.
As this information may be of interest to other members of the public, Te Whatu Ora has may
proactively release a copy of this response on our website. Al requester data, including your name
and contact details, wil be removed prior to release.
Nāku iti noa, nā
Mark Shepherd
Regional Director, Hospital & Specialist Services Northern Region Te Whatu Ora | Health New Zealand
TeWhatuOra.govt.nz
Te Whatu Ora, PO Box 793,
Wellington 6140, New Zealand
