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

do this, PHARMAC has promulgated rules and criteria. My question of
PHARMAC developed into a study of exactly how this decision making system
works. Is the process fair? How would we know if it was fair? Who are we trying
to be fair to? What principles of fairness and equity are they aligned to?
Consequently, I developed the following research question:
My Study
How does the operation of PHARMAC’s Community Exceptional
Circumstances policy align with the distributive justice principles of
fairness and equity as described by John Rawls and Amartya Sen?
To research this question, I designed a research project which involved a
qualitative iterative policy analysis utilising a justice methodology (Prah Ruger,
2010 p79). I examined PHARMAC’s Community Exceptional Circumstances
policy by collecting data from the widest possible sources. These sources
included published literature, parliamentary records, the media and a court case
transcript. I also used key informant interviews and made extensive use of the
Official Information Act (OIA) 1986 to procure documents held by government
officials. This data were analysed using Braun and Clarke’s (2006) thematic
analysis method which produced five themes describing PHARMAC’s policy.
The Structure of This Thesis
Chapter 2 provides the background and context for this study and outlines why
this research question needs to be answered. There has been a large amount
of literature written about governments rationing public spending. I have
organised this chapter to provide the background of PHARMAC’s allocative
practices. This chapter begins with a discussion about the necessity to ration
health care and a section on the terminology used to describe these allocative
practices. This is followed by a section which explores whether it is better to
ration explicitly or implicitly. I have chosen to examine the literature around four
types of rationing: ‘macro-level’ rationing, ‘meso-level’ rationing, ‘micro-level’
rationing and rationing by the ‘Rule of Rescue’. These rationing types provide
the context for seeing how PHARMAC’s activities and purpose fit into this large
subject area.
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