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

Technological and pharmaceutical diagnostic treatment enhancements have
produced both real and perceived benefits to patients. This particularly applies
to pharmaceuticals where countries have tried to contain health spending on
new products. OECD member governments have been vulnerable to the
economic pressures of price increases and exchange rate fluctuations related to
supply and demand cycles in the international pharmaceutical market place. In
the past 20 years the pace of pharmaceutical and imaging technological
innovations have outstripped OECD countries ability to fund them (OECD,
2010). There is a limit to what governments can afford to provide.
Governments in the OECD have tried to manage these economic pressures by
setting limits and trying to define them. Authors have used a confusing number
of terms to describe funding decision making including such as words like
distributions, allocations, funding, prioritisation, budget levels, priority setting
and rationing (Ubel, 2000). The term ‘rationing’ is often used interchangeably
with the term ‘priority setting’ or ‘prioritisation’ (Ham & Coulter, 2000). Ham and
Coulter (2000b) use the terms to describe choices in health care that are made
which affect individuals, communities or countries.
Some authors refer to the distribution process only as the means of deciding
allocations of services to individual patients (Klein, 1995). Other authors’
definitions of rationing include inequitable distribution of resources based on
inability to pay (Hadorn & Brook, 1991). Brook and Lohr (1986) describe
rationing as any set of activities which determines who gets needed medical
care when resources are insufficient to provide for all. A more recent definition
describes the withholding of some medical services from selected individuals
who would probably benefit from them, because such services are not being
purchased and therefore are not available for everybody who needs them
(Rech, 2010).
Other authors (Blank & Burau, 2004; Hadorn & Brook, 1991) discuss health
service priority setting as a euphemism for the denial of a treatment to a patient
who would benefit from it. However, the fact that a person would benefit from
an investigation or treatment does not mean that, in every case, the
investigation or treatment can be provided, particularly among state funded
services. Scarcity and lack of affordability (Hall, 1994; Mariner, 1995) dictate
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