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

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Third Official Information Act Request to PHARMAC I wrote to the Stefan Crusaz, Deputy Chief Executive of PHARMAC, in response to the second OIA request and the material PHARMAC had sent to me. I explained that I was particularly interested in how the Community Exceptional Circumstances Panel made decisions. I wanted to know how the Panel applied the criteria and how the Panel weighted one criteria against another. The letter I received stated that “the Community Exceptional Circumstances panel does not write a ‘decision’ that explains the reasoning for its determination” (Crusaz S, 2009). However, the Terms of Reference – Procedure and Rules for the Community Exceptional Circumstances Panel (which were released under my second OIA request) in Section 10.1(a) [1] state that (among other things), “there is to be a full and proper record of the committee’s determination in respect of each applicant and the grounds for each determination made by the Committee” (PHARMAC 2009). There appeared to be a dissonance between the rules of operation of Community Exceptional Circumstances policy and what was actually being done. Consequently I asked PHARMAC as part of my third OIA request to provide eight recent examples of the Community Exceptional Circumstances Committee’s (or Panel 64 ) determinations in respect of applications for funding. I asked PHARMAC to provide four applications which had been approved and four applications which were declined. I asked for all the information which was put before the Committee (or Panel) for their consideration and a copy of any cost-utility analysis requested as part of consideration of any application. In these eight cases, I requested evidence of the grounds for the Panel’s decision and reference to the criteria outlined in the Terms of Reference of the Community Exceptional Circumstances Committee (or Panel) as required in Part B of the committee’s Terms of Reference. 64 In the material released which referred to the recommendations made to the PHARMAC Board “Terms of Reference for the Exceptional Circumstances Panel”, PHARMAC some times refers to the ‘Panel’ and sometimes to the ‘Committee’. 200
The following information was received from Mathew Brougham, Chief Executive of PHARMAC. and and When the EC panel meets via a two weekly telephone conference, its members discuss the application and agree whether or not the application meets the exceptional circumstances criteria for funding…the EC Panel Coordinator records the EC Panel’s determination (by way of an “approve” or “decline”) and is instructed by the EC Panel to write to the applicant to notify them of the decision. Each application for Community Exceptional Circumstances is examined by the Panel in relation to each of the three entry criteria. If none of the criteria are met, this fact is stated in the letter of decline. This is the record of the grounds for the determination made by the Panel. The Panel does not state in its response grounds on which an application is approved, but as each application is made under certain criteria the applicant can assume that …the criteria was met if the application was approved. (Brougham, 2010) PHARMAC provided the eight cases requested with the material required to meet the terms and conditions of the OIA; namely removing the identity of persons mentioned in the documents. One of the cases provided from the OIA request is attached as Appendix 7 to this thesis and the other seven cases are attached as Appendix 10 which is presented as PDF Files on the accompanying CD ROM. Examination of the Eight Cases The OIA response from PHARMAC produced eight cases which were Community Exceptional Circumstances application forms (with the names of natural persons withheld). The eight cases are discussed in the following section. Case No. 1 (OIA Document No. 81) June 2010. This claimant was a prolonged habitual intravenous drug user whose medical specialist applied to PHARMAC for Community Exceptional Circumstances funding. The claimant suffered a recent cardiac arrest and had an abnormal ECG (prolongation of the Q-T wave) indicating arrhythmia and ventricular 201
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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
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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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Page 167 and 168: The Voice of Patients and Family Me
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Page 173 and 174: Eight of the twelve persons approac
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 and 182: No we have never thought that $3 mi
Page 183 and 184: Insights were given as to the indep
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 195 and 196: make. And so PHARMAC has been a hug
Page 197 and 198: and PHARMAC is not above rationing
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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
Page 207 and 208: ….successfully…for things espec
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.
Page 231 and 232: Chapter 7: Discussion Introduction
Page 233 and 234: the intellectual property to recove
Page 235 and 236: The use of QALY’s was tested in t
Page 237 and 238: Test-Question 2 “Is this distribu
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Page 241 and 242: (2011-2012) in an open and transpar
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Page 245 and 246: Another form of decision making use
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Page 249 and 250: Test-question 4 also raises the pro
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Page 261 and 262: The data from the research showed h
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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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