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

If acceptability was to have the power of veto, a preliminary assessment of
acceptability should be placed at the front-end of the prioritisation process. This
suggestion was aimed at avoiding wasting time and resources on the detailed
analysis of changes in expenditure priorities if they were unlikely to be
acceptable. It was also argued that consideration needed to be given to the
means by which the principle of acceptability was incorporated in the
prioritisation process. This was because protecting any important residual
cultural values and norms (which were not captured by the other principles)
would not preclude inertia in resource re-allocation (Ashton, et al., 1999).
The NHC’s enduring meso-level rationing achievement was the introduction of a
booking system for some types of elective surgery. Included were cataract
surgery, coronary bypass and angioplasty surgery, total hip and knee
replacement surgery and prostate surgery (Dew, Cumming, McLeod, Morgan,
McKinlay, Dowell, & Love, 2005). The booking system was introduced because
the NHC researched waiting lists and discovered a number of anomalies and a
basic level of unfairness in the system. For example, patients were able to
game the system. They were able to get a higher place on the waiting list by
consulting a private surgeon who also operated in the public hospital. The
private surgeons were placing their patients higher up the public lists and the
surgery was provided earlier than for those patients who could not afford to see
the doctor privately. The other problem was patients and their General
Practitioners (GPs) were never clear when, or even if, the surgery would be
performed.
Weimer and Vining (2005) described the term ‘rent seeking’ as an example of
market and government failure where the policy objectives of government
expenditure are not delivered or deliver unintended objectives. They described
how powerful and influential groups in society are able to convince politicians
and officials that their co-operation and services are essential. Rent seeking is
in essence, policy choices which are made to reward such co-operation on an
ongoing basis (Weimer & Vining, 2005). The dual public/private surgical system
in New Zealand, where surgeons work as both public and private operators,
could be described as a rent seeking service. Without the co-operation of the
private surgical market of doctors and hospitals, the surgical waiting time in the
public system would be considerably longer and so the government is prepared
42