June 4, 2023

Time has come for free access to GPs and dentists

Time has come for free access to GPs and dentists

Health inequities between Pākehā and Māori are often framed as complex and difficult to change. But making access to GPs and dentists free will not only save money for whānau using these services, it will also save money for the health system and ensure Māori rights to good governance and equity under te Tiriti o Waitangi are upheld.

Waitangi Day provides us with a chance to reflect on the way in which our past shapes the present. It also invites us to think about how our decisions and actions today will impact future generations within our society.

Our health system is being transformed with the aim of providing health services that are more accessible and equitable for all people in Aotearoa New Zealand. As part of this transformation, the time has come for health care at the first point of contact, GPs and dentists, to be made free to all the people who need to use them.

We know that the fee that we pay when going to see a GP or dentist presents a major barrier for many people who need to access health services. This barrier has a bigger impact on Māori and Pacific people, it has a bigger impact on people struggling with the high cost of living and it has a bigger impact on our older people who need to have more regular contact with their GP and dentist.

This barrier to GPs and dentists prevents many people from living healthy and well lives, it impacts on their ability to work and support their whānau and it leads to higher costs within our health system when they need more complex health care that could have been prevented or managed at a much earlier stage.

Opponents to this policy change will argue that it will cost too much and it will take away the autonomy that GPs and dentists have traditionally had to set their own fees making up for funding shortfalls from the Government.

But research has shown that removing the cost of the co-payment and making visits to the GP and access to early dental care will save money. It will make living costs easier for whānau but it will also reduce the resources that are needed within our emergency departments and hospitals to care for people with complex health needs that were preventable.

The argument for the autonomy of GPs and dentists needs to be framed in a way that also includes the impact that this enduring policy has had in creating and maintaining many of the health inequities that we see in Aotearoa New Zealand.

This discussion is important within the context of Waitangi Day because te Tiriti o Waitangi sets out the constitutional obligations of our Government to ensure kawanatanga (good governance), tino rangatiratanga for Māori hapū and iwi and ōritetanga (equity) for all New Zealanders.

Does our new health system align with these responsibilities under te Tiriti? It might be moving in that direction in terms of a national system that creates space for Māori through the formation of Te Aka Whai Ora (the Māori Health Authority) and aspirations for equitable access to health services and equitable health outcomes for Māori.

But it will continue to fail to deliver on these aspirations if the people who need to use health services are unable to do so because of the cost of going to a GP or a dentist.

It is 85 years since the Social Security Act 1938 established our national health system along three distinct pathways: free specialist and hospital care paid for by the Government, subsidised GP care that requires out-of-pocket payments from the individuals using those services and private dental care outside of the public health system.

We have seen the legacy of these decisions in significant inequities in access to GP and dental care between Pākehā and Māori New Zealanders.

As someone who walks in two worlds, with a Māori mother and a Pākehā father, I have seen the devastating impact of these health inequities play out in my own whānau. It was very clear to me as a young adult that access to high quality health care that was affordable and culturally safe would have given me more time with my Māori grandparents, time that I was lucky to spend with my Pākehā grandparents.

As a health researcher, this lived experience is what motivates me to challenge the way things are within our health system. Because the way things are can be changed, if we decide as a collective that we want to change them.

Free access to GPs and dentists is one way in which we can make this change happen within our health system and ensure that future generations in Aotearoa New Zealand are able to get the health care that they need when they need it.

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