Turia Tariana: Injury Prevention Rehabilitation and Compensation Amendment Bill — First Reading 
Turia Tariana: Injury Prevention Rehabilitation and Compensation Amendment Bill — First Reading 
[Volume:634;Page:6012] 
TARIANA TURIA (Co-Leader—Maori Party) 
: 
 Tena koe Madam Assistant Speaker tena tatou katoa. I was pleased to see in the explanatory note of the Injury Prevention Rehabilitation and Compensation Amendment Bill that the Government states that it has a commitment to a fair and sustainable accident compensation system and I commend the Minister for ACC Ruth Dyson for her willingness to consider strategies that work in the accident compensation system to respond to the priorities for tangata whenua. Tena koe Ruth. 
There are two key issues we want to raise about this bill. It is a bill to discuss the merging together of two accounts—if you like balancing the books. It is also a bill that provides an opportunity to discuss access which it must be said the bill does not address well. A fair and sustainable accident compensation system must address the inequities that have been identified for so many Maori who do not access accident compensation or whose claims are denied. A fair and sustainable accident compensation system must address the lack of cultural fit. 
The other night I was reading the classic health resource  
Mauri Ora: The Dynamics of Maori Health 
. In it Professor Mason Durie stated his theory on cultural fit and I quote: “The degree of comfort individuals feel with seeking health services impacts on their use of services and in turn health outcomes. … The delivery of care in a culturally appropriate manner is an important element in determining both the willingness of people to access services and the success of any treatment or care then delivered.” 
The Maori Party comes to the Injury Prevention Rehabilitation and Compensation Amendment Bill thus thinking about these challenges. What degree of comfort do Maori have with the accident compensation system? What health outcomes do they achieve? How effective is the delivery of culturally appropriate care? And the results are not good news. Despite the fact that tangata whenua have a higher injury rate across the board they are significantly less likely to make an accident compensation claim and they are more likely to be declined cover. In other words application and take-up rate of accident compensation by Maori is significantly lower than it is by non-Maori. Although Maori made up 14 percent of the working age population in the 2005-06 year Maori were 11.3 percent of new claimants and 9.8 percent of ongoing claimants while being overrepresented in injury statistics across all age groups and in employment and in sport. What is interesting is that there is an even higher proportion of Maori claimants being declined accident compensation support. 
This data however is probably still an understatement of the real situation for Maori. It is by anyone’s account a depressing story. Indeed when we look at Maori in the peak fitness age—the 24 to 34-year-old age group—we find that injury is the leading cause of death accounting for 52 percent of deaths of Maori at this age. It is obvious from statistics about workplaces for Maori that they are overrepresented in high-risk industries. Maori aged 25 to 64 particularly men are more likely to be injured at work than non-Maori and this reflects the types of occupations in which Maori men are overrepresented such as manual and trade occupations. But there is also the bizarre fact that Maori are under-represented in accident compensation claims and entitlements. For the 2005 calendar year the claim rate per 1000 New Zealand Europeans was 361 per 1000 compared with 289 Maori. It is not a trick question but what explanation can there possibly be to respond to the fact that all the reports state that Maori have greater need but then Accident Compensation Corporation (ACC) reports less access to treatment? 
Dr Peter Jansen’s recent research on Maori consumer use and experience of accident compensation services reveals that Maori are currently not receiving entitlements to care rehabilitation and compensation at a level comparable to the proportion of Maori in the population. His research identifies four key barriers to care. The first is the cost of care. The cost of a general practitioner visit often discourages Maori from seeking assistance. Other perceived costs including prescriptions and travel expenses are also barriers. Many also express concern at the loss of their job believing that the 80 percent of previous income that accident compensation covers will not be adequate to cover their household expenses. Eighty percent of an already low income just will not pay the bills. 
The second barrier is communication including difficulty navigating the system or perhaps a lack of awareness of accident compensation entitlements. Out of the 651 participants in the survey only 56 percent said that the general practitioner had given them everything they needed to know about accident compensation entitlements. 
The third barrier is structural. Structural barriers may be created by consumers living some distance from the general practitioner or by their not being able to make appointments on time. The fourth barrier is cultural fit. Dr Jansen’s research reported consumer experiences where they felt there was no respect for Maori they could not trust the general practitioner or they perceived a level of racism. Other comments reported the discomfort that consumers felt at not being able to have their whanau with them. 
I have taken some time to share these results with the House today because I believe that the real and significant disparities between Maori and non-Maori’s accessing of accident compensation must be addressed if we are to ever achieve a fair and sustainable system. Auckland general practitioner Dr David Jansen confirms that disparities exist between Maori and non-Maori even when poverty is taken out of the equation. Fewer diagnostic tests are ordered for Maori Maori make fewer accident compensation claims and they die at an average of up to 10 years earlier than non-Maori. 
The Maori Party is disappointed that this bill—far from addressing these inequalities—may actually by an accident of its design exacerbate even further the inequities experienced by Maori. For in merging the employers’ account and the self-employed work account into a single work account the concern is that there will be disproportionate impacts on the self-employed an increasing number of whom are Maori as levies will almost certainly increase. 
There will be levy rate increases for self-employed people in high-risk industries like fishing farming and forestry. Of course those are three areas—fishing farming and forestry—where tangata whenua will be particularly effective. This is where our antennae really shot up. This bill will create another increased cost that the Maori fisheries industry will need to absorb in addition to the increased wages of the workers on foreign fishing vessels—an issue we have been rigorously opposing over the last month. 
We are also aware that costs will be increased for new businesses and those who are newly self-employed as the ACC requires the next year’s levy in advance. In a practical sense that means that 2 years’ worth of payments have to paid upfront. The possible consequences of these high levies might be that self-employed small businesses are faced with difficult choices like cutting back on health and safety equipment thus setting them up for future accidents. Given the high propensity for Maori to be involved in both high-risk and low-paid occupations the risk of compromises being made on occupational health and safety is just far too great. 
To return again to the concept of accident compensation as a fair and sustainable system I point out that an issue that sticks out is the redistribution of $96 million of levy reserves from the employers’ account to the self-employed work account. Although there is a $400 million surplus in the employers’ account the self-employed work account is in deficit. Employers have thus questioned the justice in transferring the surplus for use by groups that have not contributed to it. Employers are saying it is not right that their levies have been used to prop up the self-employed without due and informed consultation with all parties. One has to ask why the Government could not come to the party and prop up the self-employed work account. 
There needs to be more consultation and dialogue on the issue. The bill is rather evasive suggesting that the usual consultation process on the 2007-08 regulations should be bypassed so that there will be insufficient time to consult. The Maori Party simply ask that the questions that have arisen even in our brief analysis warrant making time available—time to consider why providers are seeming to give lesser and lower quality to indigenous people time to consider how Maori can identify when it is appropriate to seek treatment for injury time to consider how Maori with injury differ in expectations from other consumers and time to consider the degree of comfort the cultural fit and the health outcomes in order to ensure that future generations of Maori have an opportunity to live their full lives to their potential. 
We will support the Injury Prevention Rehabilitation and Compensation Amendment Bill through to the select committee in order to provide the time and opportunity for these questions to be heard. Tena koutou katoa.