aut.embargo	No	en_NZ
aut.supplementaryupload	Yes
aut.thirdpc.contains	No	en_NZ
aut.thirdpc.permission	No	en_NZ
aut.thirdpc.removed	No	en_NZ
dc.contributor.advisor	Waring, Marilyn
dc.contributor.advisor	Smith, John F.
dc.contributor.author	Coyle, Gregory John
dc.date.accessioned	2012-08-13T23:33:49Z
dc.date.available	2012-08-13T23:33:49Z
dc.date.copyright	2012
dc.date.created	2012
dc.date.issued	2012
dc.date.updated	2012-08-13T21:26:57Z
dc.description.abstract	This thesis explores how government funded public health agencies distribute or ration resources to citizens. Utilising John Rawls’ and Amartya Sen’s principles of distributive justice, four test-questions are proposed to assist decision makers analyse the fairness and equity of their rationing decisions. PHARMAC, the agency responsible for the procurement and subsidisation of medicines in New Zealand, is used as an exemplar through which to investigate the elements of distributive justice described by Rawls and Sen. Specifically, research was conducted into PHARMAC’s ‘Community Exceptional Circumstances’ (CEC) policy. Under this policy, in a capped government funding environment, the pharmaceutical needs of the whole society are rationed against the needs of people whose needs are considered ‘exceptional’. Data were gathered from official documents, PHARMAC’s governing legislation and a New Zealand Court of Appeal case which tested the legal validity of the CEC policies and procedures. Data were also gathered through studying 23 media stories about CEC. Key informant interviews were conducted of past or present PHARMAC senior staff, Ministers of Health and patient advocate groups. The research shows that PHARMAC’s general allocative policies have been highly successful in procuring an adequate range of quality medicines at internationally low prices, saving the New Zealand health system approximately $1.17 billion in 14 years. This has been achieved by methods of utilitarian efficiency analysis (cost-utility analysis and Quality Adjusted Life Years) and careful purchasing decisions based on evidence of clinical effectiveness. PHARMAC has also taken advantage of its exemption from Part II of the New Zealand Commerce Act (1986) using market dominance to exercise monopsonistic procurement practices. PHARMAC has been accountable to Parliament and the public and demonstrated effective use of substantive opportunities imparting the greatest pharmaceutical benefits for the greatest number of people with the funding provided to it. However, PHARMAC’s success has been achieved, in part, by managing the claims of individuals in exceptional circumstances in a way that has not closely aligned the Rawls’ and Sen’s principles of fairness, equity, openness and consistency. The research shows that using the functions required of it by governing legislation, PHARMAC well achieves its statutory purpose. However, in doing so, PHARMAC must deal with the tension between justice as fairness to individuals whose needs are exceptional, and fairness to the needs of wider society. The test-questions developed in this thesis propose a template for decision makers to explore and understand this tension.	en_NZ
dc.identifier.uri	https://hdl.handle.net/10292/4563
dc.language.iso	en	en_NZ
dc.publisher	Auckland University of Technology
dc.rights.accessrights	OpenAccess
dc.subject	Rationing	en_NZ
dc.subject	Rawls	en_NZ
dc.subject	Sen	en_NZ
dc.subject	PHARMAC	en_NZ
dc.subject	Fairness	en_NZ
dc.subject	Health	en_NZ
dc.title	How does the operation of PHARMAC’s ‘Community Exceptional Circumstances’ policy align with the distributive justice principles of fairness and equity as described by John Rawls and Amartya Sen?	en_NZ
dc.type	Thesis
thesis.degree.discipline
thesis.degree.grantor	Auckland University of Technology
thesis.degree.level	Doctoral Theses
thesis.degree.name	Doctor of Philosophy	en_NZ

How does the operation of PHARMAC’s ‘Community Exceptional Circumstances’ policy align with the distributive justice principles of fairness and equity as described by John Rawls and Amartya Sen?

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