4.1.3  …but the benefits of the technology are not equally distributed across all sections of the community.

At first glance the evidence appears favourable. It seems that New Zealanders have experienced an increase in access to these procedures. The number of operations has gone up together with the average age of people being treated. However, we need to ascertain whether these technological advances are being equally spread across the entire community by looking at the age, ethnicity and domicile of the people undergoing the operations. We also need to see whether this increase in output is achieved across all facilities.

Clearly the largest group to undergo the cardiac procedures listed are NZ Europeans at 78% of the sample with NZ Maori accounting for just 4%. Given that Maori males have an age standardised heart disease mortality rate 65.5% higher than non-Maori, one would have expected this figure to be greater if access were the same for all (See Table 6). According to Statistics New Zealand, the Maori population account for 14.1% of the population and Pacific Island people make up 6.2%. The fact that they are under represented here raises issues of accessibility and equity. The Ministry of Health has long stressed the importance of tackling cardiovascular disease particularly with regard to Maori and Pacific Island people and has devised ongoing programs to improve knowledge in the area (New Zealand Health Strategy, DHB Toolkit, Cardiovascular Disease – To reduce the incidence of cardiovascular disease, 2003). With many of these policies geared towards the long term, one would not expect instant reductions in the mortality rate. But the observed difference in access suggests that it would be useful to monitor future numbers in each major ethnic group receiving coronary procedures.

Table 6 – Numbers and Rates of Death from Ischaemic Heart Disease by Sex and Ethnicity, 1999-2001

Source: Mortality and Demographic Data 2001, New Zealand Health Information Service, Table 17, Page 22.Note: The rates are per 100000, age standardised to Segi’s world population

Of further interest is the gender balance. Males accounted for 73% of admissions while females accounted for 27%. However, this is consistent with the mortality data produced by the NZHIS (Table 6). Age standardised death rates for ischaemic heart disease were 112.8 per 100 000 for men and 59 per 100 000 for women.

4.1.4  And the age-standardised mortality rate has not decreased for all groups in society.

Table 6 also illustrates the age-standardised mortality rate over time. Notably it only incorporates data for the years 1999 to 2001 and hence there are only 3 data points for each series. Nevertheless it shows that mortality rates do not drop for ischaemic heart disease for all groups within the sample. Clearly mortality rates are related to a number of factors of which technology is only one.

4.1.5  Inter-district flows become an issue when new technology is not widely disseminated

It is important to establish where people live in relation to the place where they receive treatment. Appendix Table 1 (attached) shows the domicile DHB for each of the 49873 admissions in the sample alongside the agency providing the service. This provides information regarding inter-district flows and stresses the importance of correctly pricing hospital procedures.

Appendix Table 1 shows that there are 5 main DHB centres for the cardiac procedures; Auckland; Waikato; Capital and Coast; Otago; and Canterbury. Naturally, patients domicile to these DHBs generally have their operations performed there. What is of interest, are those patients living outside the main centres. For example, Hutt Valley, Mid Central and Hawkes Bay people are predominantly treated by neighbouring Capital and Coast; Tairawhiti patients are treated by Waikato DHB; and Southland patients are treated by Otago DHB. The numbers suggest a substantial inter-district flow towards the main centres.