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

QALY utilitarian test (Hadorn, 2006) Hadorn acknowledged that these Rule of
Rescue appeals are difficult for agencies to refuse because of the public and
political pressure which ultimately result. However, acquiescing to such
pressure contravenes the basic utilitarian assumption that the greatest good
should be provided for the greatest number. Such an equation is purported to
be possible using the QALY calculation.
Hadorn (2006) also argued that the QALY equation should not be the only
rational or moral basis for distributing resources. This is because QALYs do not
measure the need to distribute resources, the consequences of doing so or the
overall justice of including or excluding individuals from access to these
resources (Hadorn, 2006).
The International Attempts to Ration
A celebrated attempt to explicitly ration health services occurred in the state of
Oregon in 1989 when the State government tried to define which services
should be publicly funded and which should not. A Health Services
Commission was established to draw up a comprehensive list of conditions and
treatments which would be funded by the state insurance provider, Medicaid
(Klein, 1995; Oregon Government, 2007). The Commission consulted the
public widely and used research evidence and the judgment of professional
people to construct a list of medical conditions to be publicly funded. This
became known as the ‘Oregon List’. The Commission was careful to avoid
discrimination against disabled people in implementing the radical Oregon
Health Plan. The list was justified by describing the clinical effectiveness of
health treatments and calculating the ‘net benefit’ of treatments. A line was
drawn to indicate which treatments demonstrated to the health plan governors
both clinical effectiveness and net benefit. Treatments below the line were not
covered by the Oregon Health Plan (Oberlander, 2006).
The list has been expanded to include new treatments and from time to time
various treatments are moved up and down the priority ladder. For example,
cosmetic dental procedures are near the bottom of the list of funded priorities,
whereas severe head injury and loss of consciousness is the top priority
(Oregon Government, 2007). There were inconsistencies in the ranking. For
example, dental caps for pulp or near pulp exposure were ranked higher than
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