Not in my hospital? Ethnic disparities in quality of hospital care in New Zealand: a narrative review of the evidence

There are well-documented differences in health outcomes between Maori and New Zealand Europeans, some of which persist despite adjustment or control for socioeconomic status and demographic variables. Lalonde defined the health system as being a determinant of health: is it possible that the services that are designed to improve health and well-being may be contributing to the ethnic health disparities in New Zealand? This narrative review studied the evidence for disparities in the quality of public hospital care for Maori and non-Maori in New Zealand. Medline and Embase databases were employed to identify studies assessing quality of care within the New Zealand hospital setting, with the analysis of ethnic groups. The studies obtained from the search were few and varied, using an array of indicators and assessing multiple discrete clinical conditions. Investigators also exhibited differing levels of commitment to the consideration of potential confounding factors. However, there is robust evidence for the existence of healthcare disparities for Maori, in particular related to obstetric intervention and the incidence of potentially avoidable adverse events.