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

making process. He suggested that PHARMAC should give consideration to
the procedural value of fairness in its funding decision making including the
values of openness, transparency, inclusiveness, responsiveness and
accountability.
Philosopher Raanon Gillon’s paper which was written for PHARMAC in 2006
was presented by PHARMAC as background material in the discussion papers
released with the review. Contrary to Moore, in this paper Gillon suggested that
morally relevant inequalities, such that the greater the health care need, meant
the greater the presumption of a moral obligation on the State to help meet that
need. Gillon acknowledged that economists’ interpretations of this position are
regularly distorted to mean some economic calculation of need. Gillon
strenuously opposed this. He submitted that the principle of the greater the
need the greater the State obligation to meet the need should at the very least
be considered by PHARMAC in its deliberations on which drugs to fund.
Gillon (2009) proposed his own view that the definition of health care need
should be ”health care without which one’s health is harmed” (p3). He stated
that the problem with these needs is that they are individualised and are non-
comparable between people. The provision of high-cost medicines required
decision makers to make choices between incommensurables, and indeed give
weights to incommensurable alternatives.
PHARMAC used a cost-benefit analysis system and Gillon noted that, based on
QALY’s as the basic unit of measurement of fairness, this system attempts to
give weights to alternative choices. When PHARMAC compared the price of
one QALY in one treatment with the price of another QALY in another
treatment, the system relied heavily on one QALY gained, being of equal value
to any other QALY gained. Gillon cited the example of a QALY gained by going
to the South of France for a holiday being treated as equivalent to a QALY
gained by relieving pain or treating a cancerous tumour. Even comparing
QALYs gained within healthcare, a QALY gained by an insomniac is considered
equivalent to a QALY gained by a patient being treated for heart failure. Gillon
thus contended that QALYs gained by a new treatment (or QALYs gained in the
absence of need) afforded no basis for comparing the meeting of health care
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