How does the operation of PHARMAC's 'Community Exceptional ...

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Table 4: Allocating Categories to Subject Areas. Subject Area Themes Subject areas relating to PHARMAC’s operation as a meso-level rationer 14 Subject areas relating to PHARMAC’s operation as a micro-level rationer 23 Subject areas relating to PHARMAC’s moral and ethical position 13 Subject areas relating to PHARMAC’s stakeholder engagement 19 Subject areas which do not relate to any of the above subject areas 5 Total 74 Phase Five The fifth phase required ongoing analysis to refine the specifics of each category to generate clear descriptions and names for themes as they emerged. This was done by reading and re-reading all the gathered data again, however this time I had clear categories and subjects to work with. I allocated each category of data to one subject area. Many categories were regularly appearing and they were allocated to one (where possible) theme. I then allocated a name for each regularly occurring theme. The themes are presented at the end of the Research Findings (Chapter 6). Phase Six Braun and Clark (2006) describe this phase as the discussion and report writing phase. The themes from this research are discussed in the Discussion (Chapter 7) of this thesis. 106
Chapter 6: Research Findings Introduction There are six sections in this chapter which present the knowledge which has been gained from this research about PHARMAC’s Community Exceptional Circumstances policy. The first five sections relate to the data sources which were collected and analysed in the manner described in the previous chapter. The sixth section is a discussion of PHARMAC’s own review of the Exceptional Circumstances policies which was carried out between 2010 and 2011. The seventh section presents the regularly occurring themes which were produced from analysing the data. These themes are the findings of the thematic analysis. The sections in this chapter are: Section 1 The New Zealand Public Health and Disability Act 2000 Section 2 Media Study Section 3 Walsh vs PHARMAC Section 4 Key informant interviews Section 5 Requests under the Official information Act 1982 Section 6 PHARMAC’s review of Exceptional Circumstances schemes Section 7 The regularly occurring themes from the data The material in this chapter does not come with a commentary about what the data mean or what learnings can be taken from the information captured about PHARMAC’s Community Exceptional Circumstances policy. The chapter is designed to present the research data in the most detached manner possible so that the material speaks for itself. 107
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How does the operation of PHARMAC
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Applying the Test-Questions .......
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Appendix 9: Analysis of Material Re
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List of Abbreviations ABS Australia
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Attestation of Authorship I hereby
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I gratefully acknowledge Major Camp
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Abstract This thesis explores how g
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Chapter 1: Introduction What is thi
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making? Should a person’s level o
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there is no mathematical calculatio
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health, disability, treatment of ol
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I then moved to the subject of rati
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In Chapter 3, New Zealand’s past
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Chapter 2: Background Introduction
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The following journals have no auto
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Technological and pharmaceutical di
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in every sense, and attenuates the
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waiting time for first (or subseque
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Macro-Level Distributions Macro-lev
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(2000) in a report for the Ministry
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level, too many to discuss here. On
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effectiveness of treatment. However
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surgical treatment for ectopic preg
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In a study conducted by the Commonw
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They claim that health inequities c
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these presentations are correct, th
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waiting list for patient priority.
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care within finite resources. The c
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to pay for this co-operation. In 20
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Other results showed that 81% of th
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may be grounds for litigation. Henc
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determine if decisions on the appli
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Chapter 4: Philosophical Framework
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extra person with a good or service
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Page 87 and 88: The first two test-questions covere
Page 89 and 90: There was no clarity provided by th
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Page 93 and 94: Evans (2003) ranked the various typ
Page 95 and 96: The Use of the Test-Questions in Th
Page 97 and 98: Qualitative research methods were d
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Page 101 and 102: material and by working through the
Page 103 and 104: and printed copies of Hansard are a
Page 105 and 106: PHARMAC was criticised in 16 of the
Page 107 and 108: I tried to find an interviewee from
Page 109 and 110: The flow of discussion in the inter
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Page 113 and 114: 6. Producing the report The final o
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Page 117 and 118: Table 3: Tree Nodes Used in NVivo A
Page 119: At this point, I stopped using NViv
Page 123 and 124: DHBs were given the role of funding
Page 125 and 126: These measures were in response to
Page 127 and 128: Table 5: The Submitters to the Heal
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Page 131 and 132: monopolies as such. In their opinio
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Page 135 and 136: NCWNZ that S42(a) of the Bill, requ
Page 137 and 138: contentious among Maori Iwi. Any Ma
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Page 143 and 144: following text, I have individually
Page 145 and 146: Herceptin. The plaintiffs forwarded
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Page 151 and 152: confirmation that the DHB hospital
Page 153 and 154: the eight women involved in this ca
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Page 157 and 158: Judge’s Concluding Remarks The fi
Page 159 and 160: A Selection of the Media Stories Ca
Page 161 and 162: Case 4: “Worn out by endless figh
Page 163 and 164: Case 6: “PHARMAC scolded for MS-d
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Page 167 and 168: The Voice of Patients and Family Me
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was suffering would not pass the ra
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Eight of the twelve persons approac
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Part II: The Key Informant Intervie
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agreed this was done. Secondly, PHA
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the pharmaceutical schedule. The or
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No we have never thought that $3 mi
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Insights were given as to the indep
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and Now some people can say that’
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Q Be a voice for the family? A Yes,
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key issue here. Some clinicians wer
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I deeply suspect that Community Exc
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should be developing the capacity o
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make. And so PHARMAC has been a hug
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and PHARMAC is not above rationing
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This case demonstrated that the cos
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and budget management. It says this
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Q Do you recall the Kaletra issues
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Q Can I ask you about PHARMAC’s c
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….successfully…for things espec
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This was also done for the hard cop
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The Ministry of Health could not lo
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consultation documents which relate
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The following information was recei
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with the application. The discharge
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Again no report was attached from t
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The patient was also prescribed pre
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circumstances described were not su
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treatment was not unusual and the c
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their clinical circumstances would
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Theme 1. Theme 2. Theme 3. Theme 4.
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Chapter 7: Discussion Introduction
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the intellectual property to recove
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The use of QALY’s was tested in t
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Test-Question 2 “Is this distribu
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claimants (and unsuccessful drug co
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(2011-2012) in an open and transpar
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The cost-utility analysis system ha
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Another form of decision making use
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discuss how (or if) PHARMAC meets t
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Test-question 4 also raises the pro
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when there is no profound evidence
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for example value for money, equity
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Community Exceptional Circumstances
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Interferon available to a limited n
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challenges are multiple: to identif
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The data from the research showed h
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PHARMAC could be more open about st
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Chapter 8: Conclusions Introduction
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Limitations to the Research The ite
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There is no one set of indefeasible
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to alcohol and drug treatment or th
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well placed to lead further researc
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utilitarian principles of attemptin
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stand up to the same rigorous clini
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Appendices: Appendix 1: Ethics Appr
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Appendix 2: Key Informant Participa
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Appendix 3: Key Informant Consent F
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Appendix 4: Sample Interview Questi
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Appendix 5: OIA Request Greg Coyle
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Appendix 6: OIA Response from PHARM
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Appendix 7: Community Exceptional C
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Appendix 8: Community Exceptional C
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Ashton, T., & St John, S. (2008). N
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Cohen, G. A. (2008). Rescuing Justi
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Dew, K., Cumming, J., McLeod, D., M
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Glubb, N. (2011). Official Informat
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Holt, S., Harwood, M., Aldington, S
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Lindblom, C. E. (1959). The Science
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http://www.moh.govt.nz/moh.nsf/ea60
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Cash Flows (Ed.), Government of New
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PB/132 National Council of Women of
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Romano, C. (2009). Amartya Sen Shak
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Swedish Parliamentary Priorities Co
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