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

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exceptional circumstances in a way that has not closely aligned the Rawls’ and Sen’s principles of fairness, equity, openness and consistency. The research shows that using the functions required of it by governing legislation, PHARMAC well achieves its statutory purpose. However, in doing so, PHARMAC must deal with the tension between justice as fairness to individuals whose needs are exceptional, and fairness to the needs of wider society. The test-questions developed in this thesis propose a template for decision makers to explore and understand this tension. xiv
Chapter 1: Introduction What is this Thesis About? The central theme of this thesis is distributive justice. This type of justice deals with the fair and equitable distribution of a country’s resources. This subject has been written about by many people in the past, however I have drawn on contemporary philosophers John Rawls and Amartya Sen for a view of distributive justice. These philosophers have provided a useful framework by which to examine how countries meet the competing demands for all types of government services on the basis of fairness and equity. Relative to other Organisation for Economic Co-operation and Development (OECD) countries, New Zealand is not a rich country in terms of gross domestic product (GDP) per person. One important competing demand for resources is publicly provided health care. New Zealand is not alone in having limited resources for health care. Perforce, it must be decided what treatments will be provided and to whom. Some will receive treatment and some will not. The most difficult and complex problem facing all OECD governments is deciding what economic processes and what measures of justice should be applied to these decisions. People have expressed strong feelings about rationing and writers have theorised and philosophised about it. Over my life I have developed a personal and professional interest in health rationing across a variety of roles in the New Zealand public health system. I have worked as a podiatrist, health company director, university educator, health service manager, senior civil servant, principal advisor to a large non-government organisation and I have been a user of the service. I find the question as to which resources are distributed by which people, on behalf of whom, for the benefit of which people, and controlled by which people a deeply complex and fascinating study of justice and power. I have been puzzled by these questions from the first day I stepped into a hospital to begin work in 1977. There are very many types of health rationing, too many to explore in this thesis. Consequently, I have decided to examine one aspect of government 1
Page 1 and 2: How does the operation of PHARMAC
Page 3 and 4: Applying the Test-Questions .......
Page 5 and 6: Appendix 9: Analysis of Material Re
Page 7 and 8: List of Abbreviations ABS Australia
Page 9 and 10: Attestation of Authorship I hereby
Page 11 and 12: I gratefully acknowledge Major Camp
Page 13: Abstract This thesis explores how g
Page 17 and 18: making? Should a person’s level o
Page 19 and 20: there is no mathematical calculatio
Page 21 and 22: health, disability, treatment of ol
Page 23 and 24: I then moved to the subject of rati
Page 25 and 26: In Chapter 3, New Zealand’s past
Page 27 and 28: Chapter 2: Background Introduction
Page 29 and 30: The following journals have no auto
Page 31 and 32: Technological and pharmaceutical di
Page 33 and 34: in every sense, and attenuates the
Page 35 and 36: waiting time for first (or subseque
Page 37 and 38: Macro-Level Distributions Macro-lev
Page 39 and 40: (2000) in a report for the Ministry
Page 41 and 42: level, too many to discuss here. On
Page 43 and 44: effectiveness of treatment. However
Page 45 and 46: surgical treatment for ectopic preg
Page 47 and 48: In a study conducted by the Commonw
Page 49 and 50: They claim that health inequities c
Page 51 and 52: these presentations are correct, th
Page 53 and 54: waiting list for patient priority.
Page 55 and 56: care within finite resources. The c
Page 57 and 58: to pay for this co-operation. In 20
Page 59 and 60: Other results showed that 81% of th
Page 61 and 62: may be grounds for litigation. Henc
Page 63 and 64: 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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just actions by individuals. The th
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among the members of the society, a
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example of well off and powerful pe
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necessarily much advantaged over a
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among individuals and communities.
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needs. This was because distinguish
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systematic and transparent. In her
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why PHARMAC would subsidise unecono
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parents refusing treatment for thei
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The first two test-questions covere
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There was no clarity provided by th
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good may be served by their not rec
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Evans (2003) ranked the various typ
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The Use of the Test-Questions in Th
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Qualitative research methods were d
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equirements and considerable politi
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material and by working through the
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and printed copies of Hansard are a
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PHARMAC was criticised in 16 of the
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I tried to find an interviewee from
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The flow of discussion in the inter
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that the disclosure is commercially
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6. Producing the report The final o
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The following tables outline the no
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Table 3: Tree Nodes Used in NVivo A
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At this point, I stopped using NViv
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Chapter 6: Research Findings Introd
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DHBs were given the role of funding
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These measures were in response to
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Table 5: The Submitters to the Heal
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towards New Zealand and for them to
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monopolies as such. In their opinio
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for the delivery of such services (
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NCWNZ that S42(a) of the Bill, requ
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contentious among Maori Iwi. Any Ma
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Dugdale further advised that if non
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cumbersome and recommended that PHA
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following text, I have individually
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Herceptin. The plaintiffs forwarded
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the treatment of cancer in the DHB
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eligible people in New Zealand and
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confirmation that the DHB hospital
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the eight women involved in this ca
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the plaintiffs adequate opportunity
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Judge’s Concluding Remarks The fi
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A Selection of the Media Stories Ca
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Case 4: “Worn out by endless figh
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Case 6: “PHARMAC scolded for MS-d
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The drug to treat Pompe’s Disease
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The Voice of Patients and Family Me
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Sclerosis Society did this three ti
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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
Page 267 and 268:
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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279
Page 295 and 296:
281
Page 297 and 298:
283
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Appendix 8: Community Exceptional C
Page 301 and 302:
Ashton, T., & St John, S. (2008). N
Page 303 and 304:
Cohen, G. A. (2008). Rescuing Justi
Page 305 and 306:
Dew, K., Cumming, J., McLeod, D., M
Page 307 and 308:
Glubb, N. (2011). Official Informat
Page 309 and 310:
Holt, S., Harwood, M., Aldington, S
Page 311 and 312:
Lindblom, C. E. (1959). The Science
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http://www.moh.govt.nz/moh.nsf/ea60
Page 315 and 316:
Cash Flows (Ed.), Government of New
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PB/132 National Council of Women of
Page 319 and 320:
Romano, C. (2009). Amartya Sen Shak
Page 321 and 322:
Swedish Parliamentary Priorities Co
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