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

In summary, Rasiah stated that there appears to be little literature providing the
details of Community Exceptional Circumstances type schemes where explicit
rationing of pharmaceuticals to individuals occurs. Rasiah found that explicit
decision making about the funding of medicines to individuals by state rationers
is so rare that such schemes are almost non-existent outside New Zealand..
She noted this type of rationing in other countries is invariably arranged on an
ad-hoc basis (Rasiah 2009 p17). She commented that
New Zealand’s CEC scheme was the only scheme identified in the
literature that used a set number (where it stated that ‘rare’ and ‘unusual’
are considered to be in the order of 10 people nationally) as part of its
definition of exceptionality and which included an explicitly stated budget.
(Rasiah 2009 p20)
The Australian Benefits Scheme (ABS) 8 provides information to the public and
the pharmaceutical industry on medicines which are subsidised by the
government. The ABS applies to the Australian Government each year for a
specific subsidy to be set aside for very high cost medicines. There is no
allocation scheme or criteria for individual claimants for high cost medicines to
support this scheme. It is managed, as Rasiah has already pointed out, on an
ad-hoc basis.
The literature supports Rasiah’s contention that New Zealand stands alone as
an OECD country which rations pharmaceuticals by exception with explicit
criteria.
Social Inequality and Health
The literature discussed so far in this chapter has drawn on the connections
between rationing health resources and the health status of individuals and
communities. However a growing area of literature has recently emphasised
the connection between social equity and the health of societies. A discussion
on inequalities, as related to the health of individuals and societies, is relevant
to this discussion on distributive justice because social inequality has become a
way of examining access to health care and the fair distribution of resources.
The World Health Organisation (WHO) published a report on the concepts and
principles of social inequities in health in 2006 (Whitehead & Dahlgren, 2006).
8 http://www.pbs.gov.au/pbs/home
34