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

key issue here. Some clinicians were very good at using the system
and others just didn’t take the time to use it. (Interviewee D)
The interview explored how the Ministry, HFA and latterly PHARMAC knew how
many cases of a certain condition existed in New Zealand to be able to
determine if there were less than 10 sufferers with the same condition at any
one time.
Under questioning ‘D’ admitted other HFAs (or latterly the 21 DHB’s) did not
consult with each other about how many people at one time had a particular
disease. There is no system of asking all the GPs in New Zealand if they are
treating a similar number of cases of a particular disease or disorder for which
the patient’s doctor is making a Community Exceptional Circumstances claim
for a subsidy.
‘D’ was aware that cost-utility analyses were done on applications where the
total cost of the subsidy was greater than $15,000 per year. However, ‘D’ did
not know how the analyses were done nor did ‘D’ ever scrutinise any of the
reports. ‘D’ was also unaware that the cost-utility analysis excluded personal
costs to the patient and these costs were not taken into account.
Like cost-benefit analysis is taking all the costs and taking all the
benefits and quantifying the costs, quantifying the benefits and
seeing if there’s an equality or if there’s, you know, not enough
benefits or too high costs.
Q Did you know how that process was done?
A No...not really, because I mean these were, they were people that
were expert in that field, so I accepted their analysis. A would
receive a copy of their cost-benefit report and this was taken into
account when making the final decision. (Interviewee D)
Interviewee ‘E’: “Community Exceptional Circumstances is used by PHARMAC
as an ‘escape valve’“
Interviewee ‘E’ was a past or present Minister of Health with a long experience
of public administration and had held many Ministerial portfolios. ‘E’ had dealt
with PHARMAC as Minister and was well acquainted with PHARMAC as a
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