Let's be bold - bold goal 1
Eliminate inequities in access to medicines
Some of us, as people and groups of people in our community, face barriers to good healthcare. We need to do more to focus on these people and groups to help make sure everyone gets the medicines they need, when they need them. Our new Access Equity team will focus initially on particular medicines and how they are accessed, and by targeting in this way, we hope that we can learn lessons we can apply to other medicines and other settings. We can’t achieve this bold goal alone – it will require committed collaboration with others across the health system and across New Zealand.
Looking at inequities in access
Dr Scott Metcalfe
Dr Scott Metcalfe is a Deputy Medical Director at PHARMAC.
One of the biggest concerns facing our health sector is waste. I’m not talking about the overuse of treatments unnecessarily and wastefully. Rather, I’m talking about the waste of human life and potential when not everyone gets the healthcare they are entitled to. As a society, we lose opportunities when people don’t get to live, thrive and participate. This is especially when the causes or symptoms are preventable, treatable or curable. Individual pain and loss (now, past and future), caregiver burden and grieving families/whānau, impacted communities, and fairness, matter.
PHARMAC’s challenge, when deciding which medicines to fund, is to work out the best health gains we can secure from each proposal and then make responsible choices within the available budget while considering a wide range of factors. We then want to make sure that those people who could benefit from funded medicines are able to get and use them well.
Wasted potential includes health conditions that can be treated with medicines currently funded for that use. Not all New Zealanders get these medicines at the same rate. We know that there are differences in the use of medicines by some population groups, particularly when looked at by ethnicity. We have been working on updating our earlier research that shows significant differences in the way Māori receive medicine, in comparison with other New Zealanders. This is even before we consider that Māori have a higher burden of disease than others, particularly for heart disease, respiratory conditions, mental health and diabetes, so we would ordinarily expect a higher use of medicine in those areas to begin with.
When burden of disease is considered, there’s a significant amount of medicine that Māori are not getting. In other words, many New Zealanders are missing out on the opportunity to improve their health through the use of medicines – which is a big waste, and a serious health sector concern. This is also likely for Pacific peoples.
The bottom line is, we don’t think this situation is right, or sustainable, nor anywhere near getting the best health outcomes. That’s why we’ve adopted the bold goal of eliminating inequities in access to medicines by 2025. We have formed an Access Equity team examining why these inequities exist and to test a range of solutions.
We cannot cast-iron guarantee that we’ll achieve full equity in that timeframe. But the more progress we can make, the more New Zealanders will get better health from funded medicines. And that’s got to be good for all of us.
Inequities in access – a community view
Te Ropu Poa
Te Ropu Poa, a member of PHARMAC’s Consumer Advisory Committee, is General Manager of Te Hau Ora O Ngāpuhi, a Far North Māori health service provider based in Kaikohe.
There’s no need to convince Te Ropu Poa about inequities in healthcare. She sees them every day.
Te Ropu runs a health service in Kaikohe in the Far North, Te Hau Ora O Ngāpuhi. There’s one health practice in town, serving a large and geographically spread, mainly Māori, population. Meanwhile, up the road in Kerikeri, there are four GP practices alone.
“We have skin infections, preventable illness because of low vaccination rates, rheumatic fever, respiratory illness from poor housing, you name it,” she says. “Access and cost are the two big factors. If you live out in the country and there’s no public transport, no bus service, getting into town is hard. Then there’s the cost of a doctor’s visit, or the prescription charge. A $17 doctor visit is a lot if you are on a benefit.”
This can mean that people often don’t seek medical care until they are very sick – “it’s a last resort.”
A 15-minute doctor’s appointment may not be enough time for people to talk through complex issues and understand what a medicine is for or how to use it. As a result, people don’t fully understand the medicine and don’t take it as intended.
Te Ropu says much of her focus is on offering people practical help and helping them understand the need to seek early intervention to better manage their health, and children’s health.
Inequities in access – a researcher’s view
Dr Pauline Norris
Dr Pauline Norris is Professor of Social Pharmacy at University of Otago School of Pharmacy.
The first step towards reducing inequities is to understand why they occur, which is where researchers like Dr Pauline Norris come in.
Professor of Social Pharmacy at the University of Otago school of pharmacy, Dr Norris has conducted research into differences in medicine use across ethnic groups in New Zealand.
“There is a growing body of research showing there are ethnic disparities in access to medicines,” says Dr Norris.
“There has been some work done in Pacific communities, but mainly among Māori, showing that despite a higher level of need there is not the high level of pharmaceutical use you would expect to see associated with that.”
Dr Norris says the differences are not limited to pharmaceutical access, and are the result of multiple and complex factors – not all of them specifically related to health. These include geographical, financial and other barriers to healthcare, people’s understanding of what medicines are and what they are for, language barriers, and family influences.
Research and acknowledging the issue is a first step towards effecting a positive change.
“We need research and policy working together,” she says. “There are a lot of things affecting this, a lot of processes, and we really need to be working out where we can intervene to make a difference. That’s where research is really important.”
Last updated: 13 December 2018