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

Well a State Agency does the work for the government, good or bad,
and the Chief Executives are expected to handle the flack on behalf
of the Minister, and they do. The DHBs are in a slightly difficult
position because they offer up the budget that they think is
appropriate for the purchase of pharmaceuticals to PHARMAC to
manage for them, and presumably this amount is part of the wider
DHB budgeting process…I wouldn’t know about that now. But the
DHBs also have the Minister approving the final amount to go to
PHARMAC. I know that there are some pretty intense discussions
which go on to settle this stuff. The DHBs ought not to be too
concerned because PHARMAC is delivering internationally… just
incredible value for the dollars spent on drugs in New Zealand.
(Interviewee E)
‘E’ discussed the philosophical framework in relation to the political process
related to the rationing process, which inevitably ends up approving or denying
a pharmaceutical subsidy to either a manufacturing company or an individual.
I have always thought the utilitarian concept of greatest good for the
greatest number, which tries to meet the needs of those who have
not very much first, is all very well until you hit the political process.
Politicians see themselves as trying to manage not just the politics of
health but education, welfare, housing, and defence
etcetera…everything else. They want to keep doing it [remain in
government] because they believe they can do it better than the
other crowd. So when the political situation demands a compromise
on what we would all like to do, then the slavish adoption of
utilitarianism goes out the window. (Interviewee E)
‘E’ believed that PHARMAC should also be developing a capacity for the
political process and the community making rationing decisions together.
Amartya Sen is a pragmatic economist and is much more realistic.
He talks about welfare economics and a government’s duty to
develop the capacity of a society. This is a bit different from the
individualist view…you know…rather than the rights of every person
to satisfy their self interest. I suppose in these terms PHARMAC
178