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

Chapter 2: Background
Introduction
In this chapter, I provide the background for my research into the operation of
PHARMAC’s Community Exceptional Circumstances policy and the various
descriptions of rationing.
The literature in this chapter is organised into the following sections:
Why ration health care;
Rationing terminology;
Explicit or implicit decision making;
Macro-level rationing;
Meso-level rationing;
Micro-level rationing;
The Rule of Rescue;
International attempts to ration; and
Rationing by social inequality.
The chapter begins with a discussion about why health rationing is necessary.
There are four categories of rationing described. The first category is macro-
level rationing. This is done by governments making budgeted appropriations
to the various health agencies, for example New Zealand’s DHBs. The second
category of rationing is meso-level rationing. This is where the funding from
agencies is provided to services in regions, districts or where agencies are
funded to provide services which are nationally directed. The third category is
micro-level rationing. This is the distribution of public health funding to (or on
behalf of) individuals. PHARMAC’s Community Exceptional Circumstances
policy is an example of micro-level rationing. The Rule of Rescue is discussed
as another form of rationing. This is where health funding is provided in
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