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

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
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