This article was first published by 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 responds:

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.

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.

By Layla Bailey-McDowell of RNZ.