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

care within finite resources. The committee acknowledged that the public
health system would always remain shackled to patients queuing for services
and as Scott (2001) had already pointed out, queuing was also a form of
rationing. However, the NHC’s major work, described by Bloomfield (2003), was
a rejection of an Oregon-style list and agreement on prioritisation principles.
The NHC developed booking systems to replace hospital waiting lists and
promulgated guidelines and clinical priority access criteria.
The general thrust of the NHC was to develop mechanisms for prioritising
patients within services rather than prioritising between services (Manning &
Paterson, 2005).
As opposed to the original NHC concept of a core list of what would be
provided, the Committee saw its task as making it clear when services should
be publicly funded. The Committee tried to identify under what circumstances
services would be beneficial, who should receive the services first and how long
individuals should have to wait (Edgar, 2000).
The NHC designed its own framework for thinking about priorities and used four
principles: benefit, fairness, value for money and acceptability in its work. They
published four reports: the National Advisory Committee on Core Health and
Disability Services Reports in 1992, 1993, 1997; and the National Advisory
Committee on Health and Disability in 1997 10 .
Ashton, Cumming & Devlin (1999) in a major report to the HFA identified the
principle of acceptability on which prioritisation should be based. They argued
that because there were winners and losers from this process, the rationing 11
debate would be clouded by a lack of information and objectivity (Ashton, et al.,
1999). They cautioned that the principle of acceptability would carry with it the
power of veto. Because the veto was present, there was also a need for
detailed analysis, openness and clarity to support the prioritisation decisions.
The other side of acceptability was the need for concordance with cultural
values and norms. Ashton et al. (1999) presented two further arguments.
10 These 4 reports are available on the National Health Committee’s website
http://www.nhc.health.govt.New Zealand/moh.nsf/indexcm/nhc-publications
11 The word ‘prioritisation’ is used in the report instead of ‘rationing’.
41