Roy Heather: Questions for Oral Answer — Questions to Ministers 
Roy Heather: Questions for Oral Answer — Questions to Ministers 
[Volume:615;Page:11169] 
8.  
HEATHER ROY (ACT) 
 to the  
Minister of Health 
: Given the Prime Minister’s statement that the Government’s policies are to be “thoroughly based on need” will she remove the loading for funding primary health organisations that provides 20 percent extra funding for patients of the same sex income and age simply because a patient is Maori; if not why is primary health organisations funding based on race not health needs? 
Hon ANNETTE KING (Minister of Health) 
: 
 Some members have consistently failed to understand the formula for primary health organisations. There are five factors that make up the formula: the age of patients; the gender mix; the ethnicity mix; the level of deprivation in the community using the New Zealand deprivation index; and the number of high-user health cards. The funding is allocated to the primary health organisations on the basis of those five factors and then the benefits are spread across all patients of that primary health organisation irrespective of race age gender religion or income. 
Heather Roy 
: Can the Minister explain why the Minister of Maori Affairs Parekura Horomia on a Minister’s salary of $195000 is eligible for $10 visits to his doctor simply because he lives in a Maori-loading area while someone living in Invercargill who earns just $20000 a year pays $50 for a doctor’s visit? 
Hon Annette King 
: Disparities in terms of what people have paid have existed for a long time because only those with a community services card were considered to be poor enough to have subsidised primary health-care. However what this Government is doing is restoring funding to subsidise primary health-care. We started with those with the highest need first we then moved to all of those under the age of 18 and in July we are going to fund all those over the age of 65. 
Steve Chadwick 
: Does the Minister consider funding of health on the basis of age as is the case with the under-sixes policy the recent under-18 policy and the soon to be introduced over-65 policy to be ageism rather than funding on the basis of need? 
Hon ANNETTE KING 
: That is a very good question. No because there is obviously a link between age and the need for health care and that is well established. The highest users of health care are the youngest and the oldest in our community particularly the oldest. However there may be a child of a millionaire who is receiving a free under-six visit in Invercargill; we have not been funding that policy on the basis of individual need but across all under-sixes. 
Dr Lynda Scott 
: Is the Minister aware that only 9 percent of general practitioners think primary health organisations will improve health care; and as the best predictors of death and illness are poverty and poor health will she scrap the divisive race-based funding for the access formula for primary health organisations and return to funding patients on their individual need not on race? 
Hon ANNETTE KING 
: The funding for primary health organisations is based on need not on race. I would have thought a person who was a doctor would have some understanding of population health; would have some understanding of the high health needs of low-income New Zealanders of Pacific and Maori people in New Zealand of older people in New Zealand and of people who live in different parts of New Zealand. 
Rt Hon Winston Peters 
: Which party introduced the greatest number of Maori health providers and what has she read since then of that party disowning its authorship of that policy? 
Hon ANNETTE KING 
: The development of Maori health organisations and Maori health providers occurred in the 1990s under a National Government. In fact I have read very recently comments Bill English made when he was the Minister of Health where he said that one of National’s major achievements was to develop Maori health providers and funding for them. I do not know why it was all right then but is not now. 
Metiria Turei 
: Does the formula used to fund primary health organisations bear any resemblance to the Targeted Funding for Educational Achievement introduced into schools in 1995? 
Hon ANNETTE KING 
: Yes. In fact the funding for primary health organisations is very like the decile funding that was introduced in 1995 then increased in 1996 1997 1998 and 1999. It had six factors: income occupation educational qualifications household crowding income support and—wait a moment—a weighting for Maori and Pacific students. 
Rt Hon Winston Peters 
: I raise a point of order Mr Speaker. I have read the speech Dr Brash made at Orewa and what the Minister says therefore cannot possibly be true. I want her to reflect on that and confirm whether she is telling the truth or not. 
Hon ANNETTE KING 
: I am happy to table the papers on decile funding for schools which started in 1995 and was increased each year in 1996 1997 1998 and 1999 under the previous Government so that the member can see that I am in fact telling the truth. 
Mr SPEAKER 
: The member knows that the original point of order was not a point of order and that comment was out of order too. 
Hon Richard Prebble 
: I raise a point of order Mr Speaker. It arises straight out of this point of order. The Minister says that we can now see that she is telling the truth. She just gave an answer where she said that the funding for these primary health organisations was not based on race then she got up and said it is based on a similar formula to education read them all out and said that the final category is Maori. Well that is race. How can the Minister possibly say there is no race-based formula then say it is based on Maori or are Maori not a race any more? 
Mr SPEAKER 
: The member has made his point in his point of order. 
Stephen Franks 
: Can the Minister please explain why Janet Mackey who is on over $112000 per year can get her local doctor’s help solely because she can hitch-hike on the Maori loading for her local public health organisation— 
Mr SPEAKER 
: I prefer members of Parliament to be left out of this particular type of question. I am perfectly happy for any other person to be referred to. It might not strictly speaking be within the Standing Orders but I would prefer that we not use members of Parliament in this way unless it is a specific reference to a specific action that the member himself or herself has actually taken. 
Hon Richard Prebble 
: I raise a point of order Mr Speaker. I just remind you that I listened in this House to a Labour Opposition of which you were part and you yourself frequently raised and pointed out to the country the fact that a member of Parliament was on a certain salary and getting this or that privilege and a member of the public was not. In this case it is perfectly reasonable to take Janet Mackey as an example because she happens to live in an area where the Government is giving a special loading based on race then extending it to others who happen to live there without extending it to other people in New Zealand who have exactly the same circumstance. Using a member of Parliament is a very good way of pointing out—because every one knows that MPs do not get the average wage—how inequitable and unjust the Government’s race-based formulas are. 
Rt Hon Winston Peters 
: The suggestion is that the question is hypothetical and is therefore ruled out on those grounds. The second thing is that the question implied that a member of Parliament is unwell or sick and in need of health services when everyone knows that Janet Mackey is the picture of health. For that reason it should be ruled out as well. 
Mr SPEAKER 
: I refer members to Speaker’s ruling 37/6: “I cannot see that I should rule out of order a reference to the status of a member but I should like to discourage this practice because I believe there is a distinct danger of reducing the standard of our debates if members refer to the status and private affairs of other members.” I will not rule the question out so I will allow the member to ask the question if he so desires. 
Hon Richard Prebble 
: I raise a point of order Mr Speaker. I am obliged to you for your ruling but I just want to draw it to your attention and that of the House that yesterday when Labour members of Parliament rose and said that Dr Brash in promoting a tax cut would personally get I think $168 you did not object. I say that this question is just the reverse coming back at them. 
Mr SPEAKER 
: All I can say is I made a mistake. I do make mistakes. I do not claim to be perfect. I apologise. I now ask the member to ask his question. 
Stephen Franks 
: May I begin again? 
Mr SPEAKER 
: Yes start again. 
Stephen Franks 
: Can the Minister of Health explain why a member of Parliament from Gisborne who may earn more than $112000 per year can get her local doctor’s help for $15 solely by hitch-hiking on the Maori loading in that public health organisation while a poor white worker in Invercargill with exactly the same symptoms must pay $50; exactly how does that represent discriminating on needs not race? 
Hon ANNETTE KING 
: I can justify it on the grounds that an ACT list MP in Wellington could get free under-6 care for his children because it is based on a number of factors not just on race. This Government is moving to ensure that all New Zealanders will have affordable primary health-care not just those who have a community services card or a high-user health card some of whom could be millionaires. 
Metiria Turei 
: Has the Minister received any reports or concerns from the ACT member who raised the primary question about health funding targeted by age gender or ethnicities other than Maori; if not does she conclude that this can be only a race-based attack of the most dangerous kind? 
Hon ANNETTE KING 
: I cannot recall having any representations from the ACT member Heather Roy in relation to any other ethnic group. I do not believe I have had any other representations. But there does seem to be a little bit of talking out of both sides of the mouth on this issue. 
After all I do have here an email that was sent by Sue Ryan press secretary to Richard Prebble to someone on Tuesday saying that ACT would not cut funding for kohanga reo. However ACT does not really want to defend National because National made so many mistakes including cutting benefits in the 1990s. 
Hon Richard Prebble 
: I raise a point of order Mr Speaker. Could we have that email tabled? 
Mr SPEAKER 
: Is the Minister seeking leave? 
Hon ANNETTE KING 
: I seek leave to table an email dated Tuesday 17 February from Sue Ryan press secretary to Richard Prebble. 
Document by leave laid on the Table of the House. 
Deborah Coddington 
: How can she claim that Labour’s policies are based on need and not race when the Ministry of Health website explicitly states that if doctors have a majority of Maori and Pacific Island patients they get 20 percent more funding than doctors with a majority of Pakeha patients? 
Hon ANNETTE KING 
: They also get 20 percent more funding if they have a majority of people who are elderly or young. They get 20 percent more funding if they have a majority of low-income people people who are deprived. I read out five factors that have a 20 percent loading based on need not race. 
Rodney Hide 
: I raise a point of order Mr Speaker. I do ask you to consider the Minister’s answer to that question which in no way addressed the issue which was the fact that Maori have a 20 percent loading. Just because there is a loading for age does not get away from the fact that the formula is race based. 
Hon ANNETTE KING 
: It is age based. 
Rodney Hide 
: It is also age based but it is race based as well. 
Mr SPEAKER 
: As far as I am concerned the Minister addressed the question. 
Rodney Hide 
: I raise a point of order Mr Speaker. I do apologise to you but the Minister was calling out when I was making my point of order. Normally you assist a member who is being attacked when he or she is making a point of order. 
Mr SPEAKER 
: I think that is a fair comment. I will ask the Minister to stand withdraw and apologise. 
Hon ANNETTE KING 
: I stand withdraw and apologise. 
Heather Roy 
: Can she deny that doctors in primary health organisations are funded 20 percent more for Maori and Pacific Island patients than for other patients where more than half those enrolled are Maori or Pacific Island New Zealanders and can she deny that this is the first time since the creation of the welfare State that central government has large-scale subsidised doctors’ visits on a race basis? 
Hon ANNETTE KING 
: I read out the factors that make up the formula. They actually have a 20 percent loading on each of them: age gender ethnicity deprivation and high-user health cards. They are the weightings. I notice that the member is not objecting to our putting more money in for gender for age or for deprivation—only for Maori. I wonder why. 
Hon Richard Prebble 
: I raise a point of order Mr Speaker. The Minister was kind enough to table my press statement so would she now be kind enough to table the formula for primary health organisations. 
Mr SPEAKER 
: Only if the Minister herself wishes to ask for that leave. 
Hon ANNETTE KING 
: Can I assist the member and suggest that if he looks at the website of the Ministry of Health he will find the formula there. 
Dr Lynda Scott 
: I seek leave to table the question asked of general practitioners in the survey—“Do you think the PHO framework will deliver better care to patients?”—to which only 9 percent of 300 general practitioners said “Yes”. 
Mr SPEAKER 
: Leave is sought to table that. Is there any objection? There is. 
Deborah Coddington 
: I seek leave to table the text from the Ministry of Health website that does set out the loading for Maori and Pacific Island patients of 20 percent more funding. 
Mr SPEAKER 
: Leave is sought to table that text. Is there any objection? There is. 
Nandor Tanczos 
: I raise a point of order Mr Speaker. I have raised this question with you before and I realise I referred to it wrongly but I just wanted to remind the House about Speaker’s ruling 127/8 which states: “Leave should only be sought to table papers that are not readily available from other sources. The tabling of a document is not an occasion to make a point; it is an opportunity to produce for the House a paper that other members may not see or may not have seen.” 
Mr SPEAKER 
: Well let me just say that I think many members from all parties do occasionally seek to table papers on other than a strictly needs basis. Obviously. I deprecate it but I will not ban it.