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

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Section 3: Media Reports ..................................................................................... 144 A Selection of the Media Stories ........................................................................................ 145 Discerning the Voice of the Participants in the Stories ...................................................... 152 What Did the Headlines Say? ............................................................................................ 157 Section 4: Key Informant Interviews ..................................................................... 157 Introduction ........................................................................................................................ 157 Part I: The Interview Experience ........................................................................................ 158 Part II: The Key Informant Interviews................................................................................. 161 Section 5: Request Under the Official Information Act 1982 ................................. 194 First Official Information Act Request to PHARMAC ......................................................... 195 Official Information Act Request to the Ministry of Health ................................................. 196 Second Official information Act Request to PHARMAC .................................................... 197 Official information Act Request to the Department of the Prime Minister and Cabinet .... 198 Third Official Information Act Request to PHARMAC ........................................................ 200 Examination of the Eight Cases ......................................................................................... 201 Fourth Official Information Act Request (MidCentral DHB) ............................................... 211 Section 6: PHARMAC Initiated A Review of the Exceptional Circumstances Policy ............................................................................................... 211 Section 7: Regularly Occurring Themes from the Data ......................................... 214 The Names of Each Theme ............................................................................................... 216 Chapter 7: Discussion ............................................................................................ 217 Introduction 217 Test-Question 1 .................................................................................................... 217 Test-Question 2 .................................................................................................... 223 Test-Question 3 .................................................................................................... 228 Test-Question 4 .................................................................................................... 232 Discussion of Theme 5 from the Research ........................................................... 242 The Use of Intuition in Decision Making ................................................................ 246 What New PHARMAC System Could Emerge? .................................................... 247 Chapter 8: Conclusions ......................................................................................... 251 Introduction 251 What has this Research Discovered About Distributive Justice? .......................... 252 Limitations to the Research .................................................................................. 253 Development of Alternative Themes from the Data .............................................. 254 The Use of the Test-Questions ............................................................................. 254 Further Research ................................................................................................. 257 Closing Comments on the Thesis Question .......................................................... 259 Postscripts 262 Appendices: ............................................................................................................ 265 Appendix 1: Ethics Approval ................................................................................. 265 Appendix 2: Key Informant Participant Information Sheet ..................................... 267 Appendix 3: Key Informant Consent Form ............................................................ 269 Appendix 4: Sample Interview Questions ............................................................. 271 Appendix 5: OIA Request ..................................................................................... 273 Appendix 6: OIA Response from PHARMAC........................................................ 275 Appendix 7: Community Exceptional Circumstances Buprenorphine / Naloxone Application ....................................................................... 277 Appendix 8: Community Exceptional Circumstances Applications Approved Between 2001–2009 (Provided on CD ROM) ................................... 285 iv
Appendix 9: Analysis of Material Received Under the Official Information Act Requests (Provided on CD ROM) .................................................... 285 Appendix 10: Seven further cases of Community Exceptional Circumstances Applications Released under the Official Information Act (Provided as PDF Files on CD ROM) ............................................... 285 References .............................................................................................................. 286 v
Page 1 and 2: How does the operation of PHARMAC
Page 3: Applying the Test-Questions .......
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 and 28: Chapter 2: Background Introduction
Page 29 and 30: The following journals have no auto
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.
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care within finite resources. The c
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to pay for this co-operation. In 20
Page 59 and 60:
Other results showed that 81% of th
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may be grounds for litigation. Henc
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determine if decisions on the appli
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Chapter 4: Philosophical Framework
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extra person with a good or service
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just actions by individuals. The th
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among the members of the society, a
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example of well off and powerful pe
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necessarily much advantaged over a
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among individuals and communities.
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needs. This was because distinguish
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systematic and transparent. In her
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why PHARMAC would subsidise unecono
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parents refusing treatment for thei
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The first two test-questions covere
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There was no clarity provided by th
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good may be served by their not rec
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Evans (2003) ranked the various typ
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The Use of the Test-Questions in Th
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Qualitative research methods were d
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equirements and considerable politi
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material and by working through the
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and printed copies of Hansard are a
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PHARMAC was criticised in 16 of the
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I tried to find an interviewee from
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The flow of discussion in the inter
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that the disclosure is commercially
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6. Producing the report The final o
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The following tables outline the no
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Table 3: Tree Nodes Used in NVivo A
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At this point, I stopped using NViv
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Chapter 6: Research Findings Introd
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DHBs were given the role of funding
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These measures were in response to
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Table 5: The Submitters to the Heal
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towards New Zealand and for them to
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monopolies as such. In their opinio
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for the delivery of such services (
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NCWNZ that S42(a) of the Bill, requ
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contentious among Maori Iwi. Any Ma
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Dugdale further advised that if non
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cumbersome and recommended that PHA
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following text, I have individually
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Herceptin. The plaintiffs forwarded
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the treatment of cancer in the DHB
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eligible people in New Zealand and
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confirmation that the DHB hospital
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the eight women involved in this ca
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the plaintiffs adequate opportunity
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Judge’s Concluding Remarks The fi
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A Selection of the Media Stories Ca
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Case 4: “Worn out by endless figh
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Case 6: “PHARMAC scolded for MS-d
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The drug to treat Pompe’s Disease
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The Voice of Patients and Family Me
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Sclerosis Society did this three ti
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was suffering would not pass the ra
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Eight of the twelve persons approac
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Part II: The Key Informant Intervie
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agreed this was done. Secondly, PHA
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the pharmaceutical schedule. The or
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No we have never thought that $3 mi
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Insights were given as to the indep
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and Now some people can say that’
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Q Be a voice for the family? A Yes,
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key issue here. Some clinicians wer
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I deeply suspect that Community Exc
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should be developing the capacity o
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make. And so PHARMAC has been a hug
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and PHARMAC is not above rationing
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This case demonstrated that the cos
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and budget management. It says this
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Q Do you recall the Kaletra issues
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Q Can I ask you about PHARMAC’s c
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….successfully…for things espec
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This was also done for the hard cop
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The Ministry of Health could not lo
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consultation documents which relate
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The following information was recei
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with the application. The discharge
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Again no report was attached from t
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The patient was also prescribed pre
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circumstances described were not su
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treatment was not unusual and the c
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their clinical circumstances would
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Theme 1. Theme 2. Theme 3. Theme 4.
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Chapter 7: Discussion Introduction
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the intellectual property to recove
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The use of QALY’s was tested in t
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Test-Question 2 “Is this distribu
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claimants (and unsuccessful drug co
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(2011-2012) in an open and transpar
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The cost-utility analysis system ha
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Another form of decision making use
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discuss how (or if) PHARMAC meets t
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Test-question 4 also raises the pro
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when there is no profound evidence
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for example value for money, equity
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Community Exceptional Circumstances
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Interferon available to a limited n
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challenges are multiple: to identif
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The data from the research showed h
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PHARMAC could be more open about st
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Chapter 8: Conclusions Introduction
Page 267 and 268:
Limitations to the Research The ite
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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
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utilitarian principles of attemptin
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stand up to the same rigorous clini
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Appendices: Appendix 1: Ethics Appr
Page 281 and 282:
Appendix 2: Key Informant Participa
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Appendix 3: Key Informant Consent F
Page 285 and 286:
Appendix 4: Sample Interview Questi
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Appendix 5: OIA Request Greg Coyle
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Appendix 6: OIA Response from PHARM
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Appendix 7: Community Exceptional C
Page 293 and 294:
279
Page 295 and 296:
281
Page 297 and 298:
283
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Appendix 8: Community Exceptional C
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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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