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

In a study conducted by the Commonwealth Fund (2010), New Zealand’s
largely publicly funded health system was compared to Australian, Dutch, USA,
Canadian, German and British health systems for equity, access, quality,
efficiency and life expectancy. The Dutch health services scored the highest in
all categories (Davis, et al., 2010). This success was credited to the national
health reforms of 2006 which introduced a compulsory income-related health
insurance system. Care was funded by a mix of mandatory public insurance
and voluntary private insurance. The Dutch government introduced an income-
related monthly allowance for two-thirds of Dutch households to make the
insurances affordable (Schut & van de Ven, 2011).
The Commonwealth Fund found that New Zealand has the highest ranking
among countries in the study for quality of care. This measure arises from
analysis of levels of effective care, safe care, coordinated care, and patient-
centred care (Davis, et al., 2010). New Zealand’s highest quality standards
were achieved despite having the lowest health expenditure per capita cost in
the study of seven countries.
These results indicate that quality health services are not necessarily linked to
high levels of expenditure. In the same study, New Zealand ranked sixth of
seven (next to the USA) in the equity category (Davis, et al., 2010). In the
report, equity was defined by the US Institute of Medicine as “providing care
that does not vary in quality because of personal characteristics such as
gender, ethnicity, geographic location, and socioeconomic status” (Quality of
Health Care in America, 2001). In relation to these comparator countries in the
study, New Zealand provides very cost-effective care of high quality, but fails to
provide health care in the public sector to all citizens equitably.
International Attempts to Ration Pharmaceuticals by Exceptional
Circumstances
In a New Zealand thesis for a Masters Degree in 2009, Dr. Dilky Rasiah, the
Deputy Medical Director of PHARMAC, outlined the international attempts to
ration medicines to individuals by means of exceptional circumstances
schemes. The conclusions of Rasiah’s research are discussed on page 48 of
this thesis.
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