Do Māori and Pacific Peoples Living with Dementia in New Zealand Receive Equitable Long-Term Care Compared with New Zealand Europeans?

Abstract

Context: Compared to Europeans, Māori and Pacific peoples living with dementia in the Counties Manukau District Health Board region are three times less likely to use Aged Residential Care (ARC). Objectives: The aim of this study was to investigate whether reduced ARC utilisation by Māori and Pacific peoples living with dementia is equitably compensated by an increase in Home Based Support Service (HBSS). Methods: Routinely collected sociodemographic and clinical data for people diagnosed with dementia at an NZ memory service (2013–2019) were linked with administrative ARC and HBSS invoicing data. Two-part models were used to estimate adjusted costs of HBSS utilisation or ARC placement. Findings: six hundred fifty-seven people of European, Māori and Pacific ethnicity were included in the analysis. Compared to Europeans, both unadjusted and adjusted ARC costs per person-year were significantly lower for both Māori (–NZD$3580, 95%CI: –$6890, –$140) and Pacific peoples (–NZD$3110, 95%CI: –$5590, –$540) but HBSS cost per person-year was only higher for Pacific peoples (+NZD$640, 95%CI: $100, $1180) and not Māori (+NZD$180, 95%CI: –$470, $840). There was no significant difference in the combined HBSS and ARC cost per person-year for Māori (–NZD3460, 95%CI –7200, 280) or Pacific peoples (–NZD2490 95%CI –5090, 110). Conclusions: Lower ARC utilisation amongst Māori and Pacific peoples living with dementia does not translate to an equitable increase in HBSS spend. The difference is likely to be compensated by care provided by unpaid family carers. Addressing the wider determinants of long-term care use in these populations and providing alternative culturally appropriate services must be prioritised to address this inequity in allocation of public sector resources.

Keywords

• dementia
• risk factors
• longterm care
• indigenous
• Māori
• Pacific peoples