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

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Q You must have looked at thousands of these Community Exceptional Circumstances cases. A Yes, literally thousands. (Interviewee C) The interview with ‘C’ extracted considerable comment about fairness and gave a clear description about what ‘C’ saw as the elements of fairness. and Fairness is not related to the amount of money a person has, rich or poor…the amount of money they, the person I mean, has or hasn’t got. It is not related to sex or religion or ethnicity or indeed age. No, fairness is a consistent process where everybody is treated the same way and has the same capacity to get the same sort of things. Fairness is something about meeting the needs of everyone, irrespective of each person’s ability to pay. (Interviewee C) ‘C’ made reference to the needs of the individual and the need to manage the funding and recognised that Community Exceptional Circumstances was an imperfect system. ‘C’ believed that some people will miss out on the drugs that would benefit them because there is not enough benefit that can be demonstrated. On this point ‘C’ felt that the system had been in place for such a long time that it had legitimacy because of this. ‘C’ claimed that his/her understanding of Community Exceptional Circumstances was fair; therefore the Community Exceptional Circumstances scheme was fair. Well I mean it has worked okay up till now…it has been fair because I understand it and that is the important thing…so what is the problem? (Interviewee C) When asked if it was possible for another doctor or another person or even the patient to have a different view of fairness, ‘C’ responded: No not really. Fair is fair. I am the one making the decision and what I think is fair has to…well…be the right answer. (Interviewee C) 168
Insights were given as to the independence of the Exceptional Circumstances Panel. ‘C’ made comment that the panel only made recommendations and not decisions. We are independent of PHARMAC and that is why we were appointed by the Ministry of Health. We don’t work for PHARMAC in that sense. I have always felt free to decide. (Interviewee C) ‘C’ made reference to the fact that some doctors know how to complete the applications for Community Exceptional Circumstances in a way that ensures their patients will get a subsidy. This situation militates against the patients whose doctors are unfamiliar with the system of application. This contradicts ‘C’s’ own description of fairness to each patient and is a form of rationing itself. This contradiction was put to ‘C’: Q Do you think you are being fair to the patients taking a rules based attitude with their doctors? A If you meet the criteria you get the medicine and if the doctor knows how to work the criteria the person gets the medicine. I didn’t ever worry about being hard on the applications. The doctor has a set of instructions and if the doctor does not follow those instructions well… Q The patient misses out? A Yes, the patient misses out. (Interviewee C) The matter of the affordability criteria for Community Exceptional Circumstances was raised with ‘C’. The following discussion identified that despite adjudicating on thousands of cases ‘C’ had no idea of the criteria that ‘C’ and the Community Exceptional Circumstances Panel were supposed to be operating under. It was revealing to hear by ‘C’s’ own admission, ‘C’ was not aware of the criteria. At one stage, condoms were being provided free with medicine as a form of contraception to those who could not afford them. Suddenly every woman in New Zealand couldn’t afford to buy them themselves. Doctors didn’t want to argue about it, didn’t want to go around checking on their income. 169
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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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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
Page 131 and 132: monopolies as such. In their opinio
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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 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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Page 175 and 176: Part II: The Key Informant Intervie
Page 177 and 178: agreed this was done. Secondly, PHA
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Page 181: No we have never thought that $3 mi
Page 185 and 186: and Now some people can say that’
Page 187 and 188: Q Be a voice for the family? A Yes,
Page 189 and 190: key issue here. Some clinicians wer
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Page 197 and 198: and PHARMAC is not above rationing
Page 199 and 200: This case demonstrated that the cos
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Page 203 and 204: Q Do you recall the Kaletra issues
Page 205 and 206: Q Can I ask you about PHARMAC’s c
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Page 209 and 210: This was also done for the hard cop
Page 211 and 212: The Ministry of Health could not lo
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Page 217 and 218: with the application. The discharge
Page 219 and 220: Again no report was attached from t
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Page 229 and 230: Theme 1. Theme 2. Theme 3. Theme 4.
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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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