Because health status is largely determined by socio-economic factors, improvements are mainly influenced by things like income levels and housing quality. These are related to the society-wide distribution of resources. Nevertheless, health services are an important way of addressing health problems and inequalities.
Early health services
Until the 1940s most people had to pay for all health services. Poor people received free treatment at public hospitals, which were also part-funded by user charges. General practitioners (GPs) and other doctors set their own fees. Friendly societies subsidised health care for their members, who paid regular subscriptions.
Free and subsidised services
Under the Social Security Act 1938, public hospitals became free in 1939 and prescription medicines followed in 1941. From 1941 doctors received a set fee for service from the government, which they could top up by part-charging patients. Patient fees rose over time because the government subsidy did not increase in line with inflation. Prescription fees were reintroduced in 1985 and could be as much as $20 per item by the early 1990s. Hospital care remained free.
Primary health services in the 21st century
In the 21st century GPs and other health professionals grouped together as primary health organisations (PHOs). PHOs with high-need enrolled populations (Māori and Pacific people and residents of deprived neighbourhoods) received more funding per person than those with less needy populations. The formation of PHOs resulted in lower fees for most people, though some low-income people living in better-off areas paid more. Prescription charges were reduced to $3 per item for most people in the 2000s, and then raised to $5 in 2013.
Because New Zealand’s primary health service was partly funded by patient fees, cost still limited access to GPs in the 21st century. Between a quarter and a third of people put off visiting doctors or collecting a prescription because of cost. Women were more likely to defer visits than men because they had less disposable income.
While Māori, Pacific and Pākehā people had similar rates of registration with a primary health practitioner in the early 21st century, Māori and Pacific adults were more likely to put off going to a doctor when ill. Cost was the major factor, but studies also cited actual or perceived racism, and family and work commitments coming before personal health. Deferred visits sometimes meant people ended up in hospital when their health problem could have been solved by a GP at an earlier stage.
Some health services in areas with significant Māori and Pacific populations tried to make clinics more culturally friendly. In the 1980s the Plunket rooms in Kingsland, Auckland, were decorated with tapa wall hangings and Samoan mats on the floor. Plunket nurse Robin Griffiths sometimes referred Pacific mothers to traditional healers and older women in their communities.
Asian people had better health status than other ethnic groups, and their use of health services was much lower. This reflected good health, but also barriers to access such as language differences. Asian migrants’ health declined the longer they lived in New Zealand.
Focus on inequalities
Health disparities between Māori and Pākehā were written about from the 19th century. Health researchers published major reports on social inequalities in health from the 1980s. Activity in this field increased in the 1990s and 2000s. Reducing inequalities was a major part of government health policy and a statutory obligation of district health boards in the 21st century.
Māori and Pacific health providers
From the 1980s the government and health authorities took more account of Māori perspectives on health. The number of Māori and Pacific health providers increased from the early 1990s, when the government began allowing private-sector groups to tender for health service contracts. These groups provided culturally specific services on marae and in other community settings in an attempt to improve Māori and Pacific health. However, the 2002/3 New Zealand Health Survey reported that only one in seven Māori and one in 11 Pacific respondents had used these services in the last 12 months, emphasising that mainstream providers remained important to all social groups.
Cultural beliefs about the human body can influence the extent to which people use health services such as breast-screening programmes. Vaifagaloa Naseri Moepogai of Health Star Pacific Trust in Auckland said: ‘The topic of breasts, especially in the public arena, is a subject considered taboo for our women, and as such, emotions can be frail. You have to take this into consideration and be delicate and sensitive about overcoming these beliefs.’1
Major public-health programmes promote immunisation against infectious diseases, and breast- and cervical-cancer screening. They are advertised in different ways for different sections of the population. Programmes targeting individual behaviour promote healthy food, exercise and stopping smoking.
Targeted programmes have not reached all eligible people. Māori and Pacific women have lower breast and cervical screening rates and higher death rates for these cancers than other women. Child immunisation rates are low in New Zealand compared to other developed countries. Māori children have lower immunisation rates than other ethnic groups.