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

Macro-Level Distributions
Macro-level health rationing is what happens when governments allocate
national budgets for health spending. This fits into the whole of government
view of health care (Calman, 1994). Macro-level distributions of health funding
also include providing utilities such as public housing, transport, police,
education, security and care of the environment. Calman (1994) argued that
these considerations will have more of an impact on improving the health status
of the nation than spending on health care.
The Hon. Helen Clark, a former Prime Minister of New Zealand and
experienced New Zealand politician, stated that she felt she was more effective
as a Health Minister when she was Housing Minister. This was because of her
greater ability to change health status by providing adequate, affordable, safe,
clean and dry public housing for the poor, than her ability to directly affect the
determinants of health through managing health services as the Health
Minister 6 .
Ubel (2000) argues that the overall allocation of funding for health services,
particularly by neo-liberal governments setting appropriations, is based on
political perception of performance. Those responsible for macro-level rationing
must somehow observe the relationship between the effort and performance of
the service and the costs of providing it (Olsen & Street, 2007).
Ham in Health Policy in Britain (Ham, 2009) described this phenomenon in the
UK NHS attempt to manage problems of escalating health costs. He suggested
that extra government money provided to the NHS for the purpose of providing
funds for areas considered to have extraordinarily high needs did not achieve
the intended outcomes. This was because the extra funding did not create new
services to vulnerable groups such as to the elderly; it simply provided more
money for existing services. The reason for this, in Ham’s opinion, was that the
control of spending in the NHS was largely in the hands of the doctors who had
their own spending priorities. These priorities were to provide more money to
satisfy calls for more wages and greater levels of staff within the existing
service. This demonstrated the complexities of health policy and the potential
6 Personal Communication Hon. H. Clark on 2 February 2008.
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