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

performance. Theme 1 ‘PHARMAC a Success Story’ demonstrated that in
relation to PHARMAC’s first statutory purpose, PHARMAC has met the interests
of the least advantaged in equal measure to the most advantaged.
PHARMAC’s second purpose, to manage the needs of the people whose
requirements are not able to be met by the general pharmaceutical schedule, is
also examined by test-question 1. A person with a very rare disease and
whose needs are truly exceptional would be considered disadvantaged in
relation to a person who did not have a rare disease. Theme 4 ‘PHARMAC-No
Stated Philosophy’ demonstrated that PHARMAC did meet the needs of the
wider population, but struggled to meet the needs of the few least advantaged
people with rare diseases. PHARMAC’s approach ensures that medicines
required by those who suffer more common illnesses are subsidised in greater
volumes and at a low comparative cost. The pharmaceutical needs of people
with rare diseases, or diseases requiring very high-cost pharmaceuticals,
cannot all be met by this micro-level rationing approach.
Much of the literature and several contributors to the research questioned the
accuracy and fairness of the QALY cost-utility approach in determining the
utilitarian position. The first concern was that QALY’s cannot be accurately
compared to each other, and, if this is a valid criticism, the whole basis for the
cost-utility analysis may be fundamentally flawed. The second criticism was
that QALY’s failed to give consideration to the non-government (actual and
opportunity) costs incurred by the patients. QALY’s did not have the ability to
measure the comparative value to the patient of being returned in a healthier
state to the workforce and to the community. This is one of the primary
purposes of healthcare. In these ‘exceptional’ cases, the costs and benefits are
impossible to measure. Several contributors to this research stated that while
such costs are very difficult to measure, even more difficult to compare, this
does not mean these costs and benefits do not exist. It simply means that
QALYs are an inadequate tool for measuring such desired outcomes.
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