Ethnic disparities in hospital care in New Zealand

Research by the University of Otago, Christchurch indicates there may be disparities in the quality of public hospital care for Māori inpatients in some clinical areas.

Dr Juliet Rumball-Smith from the Department of Public Health and General Practice has just concluded a review of 11 studies which examines the issue of quality of care and ethnicity in relation to specific conditions and procedures.

International research shows that there is substantial evidence of ethnic disparities in health care quality for minorities, particularly in the USA. This study was done to assess the evidence for similar disparities in New Zealand.

A difference in the rates of quality measures between ethnic groups is considered a 'disparity' if it is associated with poorer health outcomes (or inconsistent with clinical need), and is present despite consideration for patient factors, such as socioeconomic position or severity of condition.

"There's robust evidence provided by some, but not all, of the reviewed investigations for poorer quality of care for Māori. The evidence for disparities in obstetric care is particularly consistent and robust ,"says Dr Rumball-Smith.

Four of the 11 studies looked at obstetric interventions in hospitals and Rumball-Smith concludes in her review that collectively these obstetric studies show disparities in quality of care for Māori women compared to non-Māori.

For example, inequalities in the rates of acute caesarean section and induction of labour persist after control for patient and clinical variables. These findings are inconsistent with clinical need, given that Māori are more likely to experience high risk pregnancies than non-Māori.

Other clinical areas examined included adverse events, cardiac intervention, end stage renal disease, post-tympanostomy tube insertion, and care of patients with mental illness.

Because of the varying nature of these studies, their small samples, and statistical and confounding issues, it was not always possible to determine if health care differences between ethnic groups represented disparities. That is if they were associated with worse health outcomes and were still present after taking into consideration patient/clinical factors.

However Dr Rumball-Smith concludes that each separate study noted differences in the quality of in-hospital care for Māori compared to non-Māori. In most, these differences meant poorer treatment according to current standards or clinical need.

She says that it is likely that multiple factors contribute to hospital care disparities for Māori inpatients. The US Institute of Medicine considers that factors involved with the health system, individual patients, and how patients and health care workers interact all have a role.

"We know that Māori experience worse health outcomes than non-Māori at every level of deprivation. What we need is research that informs solutions; interventions to address this 'outcome gap'. It's possible that the care received by Māori within our health system may be contributing to their poorer health status, and some of the investigations reviewed in this study provide evidence of this."

This study has been published in the New Zealand Medical Journal and was funded by the Health Research Council of New Zealand. It is part of a longer investigation that aims to assess rates of readmission and levels of patient satisfaction for Māori and NZ Europeans within public hospitals in New Zealand.

For further information contact

Dr Juliet Rumball-Smith
Department of Public Health and General Practice
University of Otago,Christchurch
Email juliet.rumball-smith@otago.ac.nz

A list of Otago experts available for media comment is available elsewhere on this website.