ACT is heading into the 2026 election campaigning to scrap preferential Māori and Pacific entry pathways into medical school, even as the Government review intended to assess those programmes remains out of public view.
The debate goes directly to one of the most persistent challenges facing the health system — whether Aotearoa has enough Māori and Pacific doctors to serve communities that continue to experience significant health inequities.
The National-ACT coalition agreement committed the Government to reviewing the University of Auckland’s Māori and Pacific Admission Scheme, known as MAPAS, and the equivalent pathways at the University of Otago to determine whether they are achieving their intended outcomes.
Ministry of Health documents confirm the review was a specific coalition commitment and that Māori and Pacific medical student organisations had raised concerns about its potential impact.
But with ACT now taking a clear election position against preferential entry, the findings of the review itself have yet to be publicly released.
ACT wants admissions based on academic achievement
At the heart of ACT’s position is its longstanding argument that ethnicity should not determine preferential access to public institutions.
The party wants medical-school admissions based on individual achievement rather than ethnicity and is campaigning to remove Māori and Pacific preferential pathways.
That sets up a significant election-year debate over what equality and equity actually mean inside a health system where outcomes are far from equal.
Supporters of equity pathways argue treating everybody identically at the admissions door ignores the historical, educational and socioeconomic barriers that have contributed to Māori and Pacific people remaining underrepresented within parts of the health workforce.
ACT’s position challenges that approach.
The universities say the purpose is health equity
The University of Otago explicitly describes its admissions policy as a mechanism for developing a health workforce that better represents the communities it serves.
Its current admissions framework includes equity groups for Māori, Indigenous Pacific peoples, people from refugee backgrounds, socioeconomic disadvantage and rural communities.
The university says increasing workforce diversity and cultural competence is intended to contribute to more equitable health outcomes.
For entry into medicine, applicants considered through equity pathways still face academic and programme requirements.
At Otago, Health Sciences First Year applicants must pass the required papers with at least a 65 percent average, while domestic applicants must also meet specified UCAT thresholds. Equity applicants must additionally satisfy requirements establishing their eligibility for the relevant group.
That distinction matters because describing the programmes simply as reserved medical places can obscure the fact that students still have to meet academic and professional requirements.
Māori doctors remain part of the health equity equation
For Māori, the argument reaches well beyond university admissions.
The fundamental question is whether the health workforce reflects the population it serves and whether increasing the number of Māori health professionals contributes to better access, trust and outcomes for whānau.
That is particularly important when health services are attempting to address entrenched inequities in areas including cancer, cardiovascular disease, diabetes, mental health and access to primary care.
A Māori doctor is not automatically a better doctor for every Māori patient, just as ethnicity alone cannot determine clinical competence.
But representation, cultural understanding and the ability to build trusted relationships with communities are legitimate considerations in workforce planning.
Otago’s own policy is explicit that its equity approach is designed around creating a workforce representative of the communities it serves.
Competition for medical school is already intense
There is also a broader issue sitting behind the political argument: New Zealand simply needs more doctors.
Medical-school admission is fiercely competitive.
Otago recorded 1,141 applications for its 2026 medical programme and 347 admissions, compared with 1,003 applications and 293 admissions in 2022.
For 2027, Otago says approximately 322 domestic places are available across its admissions categories.
Meanwhile, the Government has been considering expanding domestic medical training, including through the proposed University of Waikato medical school.
Ministry advice has already highlighted another major constraint: finding enough clinical placements for increasing numbers of medical students.
That means the bigger health workforce challenge is not simply about who receives the existing places.
It is also about how many doctors New Zealand trains, where they train, where they eventually practise and whether communities with the greatest workforce shortages benefit.
Where is the review?
That brings the argument back to the Government’s review.
If MAPAS and Otago’s pathways were reviewed specifically to establish whether they are achieving their intended outcomes, then those findings are highly relevant to any decision about their future.
If the evidence shows the programmes are ineffective, that evidence should be available for scrutiny.
If it shows they are successfully increasing the number of Māori and Pacific doctors and contributing to a more representative health workforce, that should equally form part of the political debate.
The Ministry’s own briefing confirms that student organisations NZMSA and Te Oranga had expressed opposition to the review and asked for engagement with Māori and student leaders.
With ACT now campaigning for the programmes to go, questions about transparency become increasingly important.
A major Election 2026 fault line
The issue is shaping up as another clear ideological divide heading towards the November election.
ACT sees ethnicity-based preference as fundamentally inconsistent with equal treatment.
The opposing argument is that equity policies exist precisely because decades of formally equal treatment have not produced an equitable health workforce or equitable health outcomes.
For Māori, there is also a Te Tiriti dimension around participation in the health workforce and the ability of Māori communities to develop Māori health capability.
There is a legitimate political debate to be had about whether current university pathways are the best mechanism for achieving those goals.
But that debate should be informed by evidence.
If the Government commissioned a review to determine whether Māori and Pacific medical pathways are working, then before New Zealand decides whether to scrap them, the obvious question is: what did the review actually find?
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