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

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emergency or last chance situations. Specific examples to illustrate each category of health rationing are presented. The international attempts to ration involve significant projects and references to New Zealand as a leader in this process and for this reason I have given international comparisons. Finally, the subject of social inequality is discussed because this was a primary purpose for the health reforms which established PHARMAC as a Crown Agency. Literature Search Strategy A literature search was conducted utilising AUT Library access to Proquest database and conducting a Boolean Search using 3 search strings of words. These were: 1. Health AND rationing AND fairness AND “New Zealand 2. Rawls AND Sen fairness AND equity AND Health 3. “Decision Making” AND criteria AND “New Zealand” AND Pharmaceuticals AND PHARMAC AND Exceptional Circumstances This search strategy produced peer reviewed journal articles, books with relevant chapters, theses and national and international government reports. Assistance for the construction and activation of the search of this topic was provided by the AUT Postgraduate Librarian, Robyn Ramage and AUT Faculty of Health and Environmental Sciences Librarian, Andrew South. During the course of the research and writing of the thesis a literature watch was activated (again with the assistance of librarians). This consisted of RSS, and Bloglines and a set up on the TicToc Website. The export RSS feeds were set up to watch for the following journals on my reader; - Health (1363-4593) - Health economics (1057-9230) - Health economics, policy and law (1744-1331) - Health policy (0168-8510) - Policy studies (0144-2872) 14
The following journals have no automated alerting functionality. For these journals, I regularly visited their websites and reviewed the latest issues: - Health policy research (1496-466X) http://www.hc-sc.gc.ca/sr-sr/pubs/hpr-rpms/bull/2010-reg-mod/index- eng.php#a17 - New Zealand Medical Journal (0028-8446) http://www.nzma.org.nz.ezproxy.aut.ac.nz/journal/index.shtml - Policy quarterly (Victoria University of Wellington, Institute of Policy Studies) http://ips.ac.nz.ezproxy.aut.ac.nz/publications/publications/list/10 Hand searchers were conducted at the AUT Library and Victoria University Law Library searching for titles related to Rawls and Sen. I also utilised the personal collections of two friends (lawyers) who had books particular to their interest in Rawls. Why Ration Health Care? Health care services are broadly described as preventive, curative or rehabilitative treatment and intervention and social support services for people with physical and mental illness and/or disability (Daniels & Sabin, 2008). No country can provide completely unlimited health care services for all its citizens (Ashton, Cumming, & Devlin, 1999; Ashton & St John, 2002; Blank & Burau, 2004; Churchill, 1987; Coulter & Ham, 2000; Edgar, 2000; Helco, 1974; Higgins & Ruddle, 1991; Manning & Paterson, 2005; Mariner, 1995; Mays & Smith, 2005; Mooney, 1998; Morgan & Simmons, 2009; Smith, 2008; Strech, et al., 2009; Ubel, 2000) Among OECD countries, few authors have questioned why rationing is necessary and most agree that rationing is positive in that it clarifies a government’s objectives and sets aspirational budget levels to achieve these objectives. Consequently, the rationing debate is not about whether governments should or should not ration, but rather how they should ration. More particularly debate concerns which health services should be provided and in what quantity, and when and to whom they should be provided? 15
Page 1 and 2: How does the operation of PHARMAC
Page 3 and 4: Applying the Test-Questions .......
Page 5 and 6: Appendix 9: Analysis of Material Re
Page 7 and 8: List of Abbreviations ABS Australia
Page 9 and 10: Attestation of Authorship I hereby
Page 11 and 12: I gratefully acknowledge Major Camp
Page 13 and 14: Abstract This thesis explores how g
Page 15 and 16: Chapter 1: Introduction What is thi
Page 17 and 18: making? Should a person’s level o
Page 19 and 20: there is no mathematical calculatio
Page 21 and 22: health, disability, treatment of ol
Page 23 and 24: I then moved to the subject of rati
Page 25 and 26: In Chapter 3, New Zealand’s past
Page 27: Chapter 2: Background Introduction
Page 31 and 32: Technological and pharmaceutical di
Page 33 and 34: in every sense, and attenuates the
Page 35 and 36: waiting time for first (or subseque
Page 37 and 38: Macro-Level Distributions Macro-lev
Page 39 and 40: (2000) in a report for the Ministry
Page 41 and 42: level, too many to discuss here. On
Page 43 and 44: effectiveness of treatment. However
Page 45 and 46: surgical treatment for ectopic preg
Page 47 and 48: In a study conducted by the Commonw
Page 49 and 50: They claim that health inequities c
Page 51 and 52: these presentations are correct, th
Page 53 and 54: waiting list for patient priority.
Page 55 and 56: care within finite resources. The c
Page 57 and 58: to pay for this co-operation. In 20
Page 59 and 60: Other results showed that 81% of th
Page 61 and 62: may be grounds for litigation. Henc
Page 63 and 64: determine if decisions on the appli
Page 65 and 66: Chapter 4: Philosophical Framework
Page 67 and 68: extra person with a good or service
Page 69 and 70: just actions by individuals. The th
Page 71 and 72: among the members of the society, a
Page 73 and 74: example of well off and powerful pe
Page 75 and 76: necessarily much advantaged over a
Page 77 and 78: among individuals and communities.
Page 79 and 80:
needs. This was because distinguish
Page 81 and 82:
systematic and transparent. In her
Page 83 and 84:
why PHARMAC would subsidise unecono
Page 85 and 86:
parents refusing treatment for thei
Page 87 and 88:
The first two test-questions covere
Page 89 and 90:
There was no clarity provided by th
Page 91 and 92:
good may be served by their not rec
Page 93 and 94:
Evans (2003) ranked the various typ
Page 95 and 96:
The Use of the Test-Questions in Th
Page 97 and 98:
Qualitative research methods were d
Page 99 and 100:
equirements and considerable politi
Page 101 and 102:
material and by working through the
Page 103 and 104:
and printed copies of Hansard are a
Page 105 and 106:
PHARMAC was criticised in 16 of the
Page 107 and 108:
I tried to find an interviewee from
Page 109 and 110:
The flow of discussion in the inter
Page 111 and 112:
that the disclosure is commercially
Page 113 and 114:
6. Producing the report The final o
Page 115 and 116:
The following tables outline the no
Page 117 and 118:
Table 3: Tree Nodes Used in NVivo A
Page 119 and 120:
At this point, I stopped using NViv
Page 121 and 122:
Chapter 6: Research Findings Introd
Page 123 and 124:
DHBs were given the role of funding
Page 125 and 126:
These measures were in response to
Page 127 and 128:
Table 5: The Submitters to the Heal
Page 129 and 130:
towards New Zealand and for them to
Page 131 and 132:
monopolies as such. In their opinio
Page 133 and 134:
for the delivery of such services (
Page 135 and 136:
NCWNZ that S42(a) of the Bill, requ
Page 137 and 138:
contentious among Maori Iwi. Any Ma
Page 139 and 140:
Dugdale further advised that if non
Page 141 and 142:
cumbersome and recommended that PHA
Page 143 and 144:
following text, I have individually
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Herceptin. The plaintiffs forwarded
Page 147 and 148:
the treatment of cancer in the DHB
Page 149 and 150:
eligible people in New Zealand and
Page 151 and 152:
confirmation that the DHB hospital
Page 153 and 154:
the eight women involved in this ca
Page 155 and 156:
the plaintiffs adequate opportunity
Page 157 and 158:
Judge’s Concluding Remarks The fi
Page 159 and 160:
A Selection of the Media Stories Ca
Page 161 and 162:
Case 4: “Worn out by endless figh
Page 163 and 164:
Case 6: “PHARMAC scolded for MS-d
Page 165 and 166:
The drug to treat Pompe’s Disease
Page 167 and 168:
The Voice of Patients and Family Me
Page 169 and 170:
Sclerosis Society did this three ti
Page 171 and 172:
was suffering would not pass the ra
Page 173 and 174:
Eight of the twelve persons approac
Page 175 and 176:
Part II: The Key Informant Intervie
Page 177 and 178:
agreed this was done. Secondly, PHA
Page 179 and 180:
the pharmaceutical schedule. The or
Page 181 and 182:
No we have never thought that $3 mi
Page 183 and 184:
Insights were given as to the indep
Page 185 and 186:
and Now some people can say that’
Page 187 and 188:
Q Be a voice for the family? A Yes,
Page 189 and 190:
key issue here. Some clinicians wer
Page 191 and 192:
I deeply suspect that Community Exc
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should be developing the capacity o
Page 195 and 196:
make. And so PHARMAC has been a hug
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and PHARMAC is not above rationing
Page 199 and 200:
This case demonstrated that the cos
Page 201 and 202:
and budget management. It says this
Page 203 and 204:
Q Do you recall the Kaletra issues
Page 205 and 206:
Q Can I ask you about PHARMAC’s c
Page 207 and 208:
….successfully…for things espec
Page 209 and 210:
This was also done for the hard cop
Page 211 and 212:
The Ministry of Health could not lo
Page 213 and 214:
consultation documents which relate
Page 215 and 216:
The following information was recei
Page 217 and 218:
with the application. The discharge
Page 219 and 220:
Again no report was attached from t
Page 221 and 222:
The patient was also prescribed pre
Page 223 and 224:
circumstances described were not su
Page 225 and 226:
treatment was not unusual and the c
Page 227 and 228:
their clinical circumstances would
Page 229 and 230:
Theme 1. Theme 2. Theme 3. Theme 4.
Page 231 and 232:
Chapter 7: Discussion Introduction
Page 233 and 234:
the intellectual property to recove
Page 235 and 236:
The use of QALY’s was tested in t
Page 237 and 238:
Test-Question 2 “Is this distribu
Page 239 and 240:
claimants (and unsuccessful drug co
Page 241 and 242:
(2011-2012) in an open and transpar
Page 243 and 244:
The cost-utility analysis system ha
Page 245 and 246:
Another form of decision making use
Page 247 and 248:
discuss how (or if) PHARMAC meets t
Page 249 and 250:
Test-question 4 also raises the pro
Page 251 and 252:
when there is no profound evidence
Page 253 and 254:
for example value for money, equity
Page 255 and 256:
Community Exceptional Circumstances
Page 257 and 258:
Interferon available to a limited n
Page 259 and 260:
challenges are multiple: to identif
Page 261 and 262:
The data from the research showed h
Page 263 and 264:
PHARMAC could be more open about st
Page 265 and 266:
Chapter 8: Conclusions Introduction
Page 267 and 268:
Limitations to the Research The ite
Page 269 and 270:
There is no one set of indefeasible
Page 271 and 272:
to alcohol and drug treatment or th
Page 273 and 274:
well placed to lead further researc
Page 275 and 276:
utilitarian principles of attemptin
Page 277 and 278:
stand up to the same rigorous clini
Page 279 and 280:
Appendices: Appendix 1: Ethics Appr
Page 281 and 282:
Appendix 2: Key Informant Participa
Page 283 and 284:
Appendix 3: Key Informant Consent F
Page 285 and 286:
Appendix 4: Sample Interview Questi
Page 287 and 288:
Appendix 5: OIA Request Greg Coyle
Page 289 and 290:
Appendix 6: OIA Response from PHARM
Page 291 and 292:
Appendix 7: Community Exceptional C
Page 293 and 294:
279
Page 295 and 296:
281
Page 297 and 298:
283
Page 299 and 300:
Appendix 8: Community Exceptional C
Page 301 and 302:
Ashton, T., & St John, S. (2008). N
Page 303 and 304:
Cohen, G. A. (2008). Rescuing Justi
Page 305 and 306:
Dew, K., Cumming, J., McLeod, D., M
Page 307 and 308:
Glubb, N. (2011). Official Informat
Page 309 and 310:
Holt, S., Harwood, M., Aldington, S
Page 311 and 312:
Lindblom, C. E. (1959). The Science
Page 313 and 314:
http://www.moh.govt.nz/moh.nsf/ea60
Page 315 and 316:
Cash Flows (Ed.), Government of New
Page 317 and 318:
PB/132 National Council of Women of
Page 319 and 320:
Romano, C. (2009). Amartya Sen Shak
Page 321 and 322:
Swedish Parliamentary Priorities Co
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