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

impenetrable and decisions were dominated by PHARMAC’s view of financial
value.
In the case of Community Exceptional Circumstances policy, PHARMAC did not
demonstrate that decisions were made primarily in consideration of a person’s
capacity to live a life they might value, but rather to ensure its own budget levels
were not breached. Making these allocative decisions is consistent with
PHARMAC’s statutory purpose and, given this set of circumstances, the gained
reputation is understandable.
Equally, PHARMAC has gained a national and international reputation of
excellence in public health rationing practice and is well regarded among New
Zealand senior government health officials. PHARMAC’s practices are now
being promoted as appropriate methods for analytically prioritising (rationing)
other health service spending and procurement. Whilst there may be challenges
to the fairness and equity considerations of implementing this idea, this research
has shown that PHARMAC is the clear leader among OECD countries for
procurement in terms of value for money.
The research has also shown how PHARMAC has achieved budget control in
operating the Community Exceptional Circumstances policy by managing the
budget and when required, giving greater weighting to the affordability decision
making criteria above the other criteria it promulgates. The research has
demonstrated that some allocative committees, for example the Community
Exceptional Circumstances Panel, did not record their reasons for making their
decisions. Again this is understandable from their point of view, however not
advising claimants of the reason for decisions is inherently unfair and provides no
level of procedural justice to claimants who are declined their claims.
The research also discovered that there is no clear set of values which have
been promulgated by PHARMAC to indicate which values guide PHARMAC’s
decision making, other than the desire to achieve budget (which is not a value
but an outcome). PHARMAC achieves this outcome by generally following the
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