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

Test-question 4 also raises the problem of the QALY calculation being blind to
the circumstances of the claimant’s capabilities. When PHARMAC utilise the
QALY calculation, it tries to quantify what contribution (or part of a contribution)
a medicine makes to one added year of life. The NHC also intend to take this
approach for the more general provision of health services. The second part of
this approach determines the cost of adding a year (or part of a year) of life. As
has been discussed previously, the cost-utility analysis only considers the
quantifiable costs to the public health service in providing the treatment.
For example, the costs which are not considered in the QALY calculation are
the costs to other government agencies of having a member of society out of
the workforce. Similarly, there are financial and non-financial benefits to the
patient of being an able family member and being able to work and contribute
to society. One case in the media study described a woman with terminal
cancer who requested a drug to enable her to cuddle her daughter. It was
suggested that these non-financial capabilities that claimants have good
reasons to value should be considered as well.
PHARMAC has strenuously avoided knowing these capacities because such
commensurables are impossible to compare from one patient to another and
the basic principle of a QALY (one QALY is equal in every way to another
QALY) would be impossibly undermined. Secondly, if PHARMAC were to
calculate the QALY’s gained for people who cannot work because of reduced
capability for example chronic illness or age, these people would be put at an
immediate disadvantage to those who can work and contribute a measurable
monetary value. Thirdly, people with co-morbidities, where several pathological
factors are at play, would immediately be put at a disadvantage. This is
because people suffering more than one condition may be considered of lesser
economic value to society than a person with only one illness to contend with.
These examples are what Sen refers to as the underlying capability, that is
valuing good health. This research has uncovered the many interpretations of
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