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

A section of the New Zealand Ministry of Health is the Health Impact Assessment
(HIA) unit which is a New Zealand wide service responsible to the Office of the
Director of Public Health. This unit attempts to measure and report the potential
long-term policy impacts on health indicators and determinants of wellbeing. The
unit was established in 2010 as part of a wider strategy to improve health and
reduce inequalities in New Zealand. One of the tools used by the HIA is the
Health Equity Indicator Tool 80 . The tool estimates potential policy impacts on
social, economic, cultural, psychosocial, behavioral and historical factors that
fundamentally determine health. It examines the pathways of these factors that
lie as root causes of health inequalities. The test-questions would be useful tools
for this unit to use in considering fair and equitable access to cost effective health
distributions across the country.
At the meso-level, it is doubtful that the test-questions would be used by DHB
Board members and managers when they are deciding on regional allocations of
funding. This is because the DHBs are constrained by the size of their budgets.
The budget levels are determined on a population basis and DHBs are often put
in the position of deciding which services to discontinue and which services to
persist with. The financial resource available to DHBs to make allocative
decisions each year on new projects is remarkably small 81 . As in macro-level
allocative decisions, the test-questions might only provide assistance to DHB
board members to reflect on and discuss the fairness and equity of providing or
not providing services to certain groups in their districts.
However, the test-questions have proved most useful in generating significant
debate about distributive justice at the micro-level of service. The test-questions
are suggested to decision makers as an opportunity to assess the elements of
fairness and equity for an individual person against other criteria required to be
satisfied before a decision is made. This process could equally be applied to
decisions about the approval of elective surgery for claimants, a person’s access
80 The details of this Health Equity Assessment Tool are provided on the Ministry of Health website. See:
http://www.moh.govt.nz/moh.nsf/ea6005dc347e7bd44c2566a40079ae6f/523077dddeed012dcc256c550003938b?OpenDocument
81I asked this question of Dr. Karen Poutasi, the Director General of Health, at an event to mark her retirement, at the Alexander
Turnbull Library, Wellington in May 2006.
256