In New Zealand in 1993, a pharmaceutical management agency (PHARMAC) was established during the height of neoliberal reforms in the health sector. The agency's relationship with pharmaceutical companies, patient lobby groups, and health professionals has been hostile at times, but despite this hostility, PHARMAC has remained substantially independent from political interference. This article draws on critical theory and Durkheimian perspectives to explain how such a strong regulatory organization was established during a time when attempts were made to reshape the health sector to conform to a neoliberal agenda. An analysis of historical and contemporary issues demonstrates the contradictory position of the state in relation to the regulation and subsidization of pharmaceuticals, with conflicting demands to retain popular support, restrain state expenditure, and respond to expectations to provide pharmaceuticals to its citizens. This article demonstrates how the establishment of PHARMAC reconciles these contradictory demands, arguing that it removes decision making from political control and has been able to sustain its place by appealing to objective assessment criteria. This case signals limits of the neoliberal agenda.
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References
1.
GauldR.Big bang and the policy prescription: Health care meets the market in New Zealand. J. Health Polit. Policy Law25: 815–844, 2000.
MetcalfeS.PHARMAC measures savings elsewhere to the health sector. N. Z. Med. J.116, 2003.
4.
Wynn-WilliamsK.Organisational Effectiveness: Debates Behind Measurement Issues in the Public Health Sector. Working Paper Series No. 17. University of Otago, Accountancy and Business Law Department, Dunedin, 2009.
5.
CombesR.Pharmacy in New Zealand: Aspects and Reminiscences. Pharmaceutical Society of New Zealand, Auckland, 1981.
6.
NorrisP.The negotiation and re-negotiation of occupational control: A study of retail pharmacy in New Zealand. Ph.D. thesis. Victoria University of Wellington, Wellington, 1993.
7.
BakerA.Setting the rules: Pharmaceutical benefits and the welfare state. In For Health or Profit: Medicine, the Pharmaceutical Industry, and the State in New Zealand, ed. DavisP.. Oxford University Press, Auckland, 1992.
8.
GroshinskiK.Judicial Review of PHARMAC. Victoria University of Wellington, Wellington, 1996.
9.
BakerA.Private Interests and Public Money: The State Provision of Medicines in New Zealand 1938–1986. Ph.D. thesis. Massey University, Palmerston North, 1996.
10.
DavisP.‘Tough but fair’? The active management of the New Zealand drug benefits scheme by an independent crown agency. Aust. Health Rev. 28(2): 171–181, 2004.
11.
NorrisP.The changing role of pharmacists and the distribution of pharmaceuticals in New Zealand. In For Health or Profit: Medicine, the Pharmaceutical Industry, and the State in New Zealand, ed. DavisP.. Oxford University Press, Auckland, 1992.
12.
TordoffJ.Evaluating the Impact of a National Hospital Pharmaceutical Strategy in New Zealand. University of Otago, Dunedin, 2007.
13.
Health Benefits Review Committee. Choices for Health Care: Report of the Health Benefits Review. Wellington, 1986.
14.
HyslopJ.DowlandJ., and HicklingJ.Health Facts New Zealand. Department of Health, Management Services and Research Unit, Wellington, 1983.
15.
CummingJ.MaysN., and DaubéJ.How New Zealand has contained expenditure on drugs. BMJ340(7758): 1224, 2010.
16.
QuinP.New Zealand Health System Reforms. New Zealand Parliamentary Library Research Paper, Wellington, 2009.
17.
Hospital and Related Services Taskforce. Unshackling the Hospitals. Wellington, 1988.
18.
National Advisory Committee on Core Health and Disability Support Services. The Best of Health 2: How We Decide on the Health and Disability Support Services We Value Most. Wellington, 1993.
19.
SimV.Drug deals, dollars and decisions: An ethical and legal evaluation of the role of PHARMAC in health rationing. Master's thesis. University of Otago, Dunedin, 2000.
20.
Pharmaceutical Management Agency. A Prescription for Pharmacoeconomic Analysis. Wellington, 2004.
21.
ZhongL.Negotiating the Price and Subsidy for Prescription Drugs: The Case of Lipitor in New Zealand. Massey University, Management Research, Palmerston North, 2003.
22.
DanzonP., and KetchamJ.Reference pricing of pharmaceuticals for Medicare: Evidence from Germany, the Netherlands, and New Zealand. In Frontiers in Health Policy Research, Volume 7, ed. CutlerD. and GarblerA.. MIT Press, Cambridge, MA, 2004.
23.
BraaeR.McNeeW., and MooreD.Managing pharmaceutical expenditure while increasing access: The Pharmaceutical Management Agency (PHARMAC) experience. Pharmacoecon. 16(6): 649–660, 1999.
24.
MooreD.Reference pricing for pharmaceuticals. In Healthy Incentives: Canadian Health Reform in an International Context, ed. McArthurW.RamsayC., and WalkerM.. The Fraser Institute, Vancouver, 1996.
25.
WoodfieldA.Augmenting reference pricing of pharmaceuticals with strategic cross-product agreements. Pharmacoecon. 19(4): 365–377, 2001.
26.
MooreD.ScottA., and WalkerM.The great debate about reference pricing of pharmaceuticals. In Healthy Incentives: Canadian Health Reform in an International Context, ed. McArthurW.RamsayC., and WalkerM.. The Fraser Institute, Vancouver, 1996.
27.
BeggE.The sorry saga of the statins in New Zealand: Pharmacopolitics versus patient care. N. Z. Med. J.116, 2003.
Ioannides-DemosL. L.IbrahimJ. E., and McNeilJ. J.Reference-based pricing schemes: Effect on pharmaceutical expenditure, resource utilisation and health outcomes. Pharmacoecon. 20(9): 577–591, 2002.
30.
GalizziM. M.GhislandiS., and MiraldoM.Effects of reference pricing in pharmaceutical markets: A review. Pharmacoecon. 29(1): 17–33, 2011.
31.
RagupathyR.A 3-dimensional view of licensed and subsidized medicines under single-payer systems in the US, the UK, Australia and New Zealand. Pharmacoecon. 30(11): 1051–1065, 2012.
32.
LessingC.Public Participation in PHARMAC: The Perspective of Consumer Groups. Master's thesis. Auckland University, Auckland, 2009.
33.
ScottA.Reference pricing: A sham and a shambles. In Healthy Incentives: Canadian Health Reform in an International Context, ed. McArthurW.RamsayC., and WalkerM.. The Fraser Institute, Vancouver, 1996.
34.
EllisC., and WhiteH.PHARMAC and the statin debacle. N. Z. Med. J.119(1236), 2006.
DanzonP.WangR., and WangL.The impact of price regulation on the launch delay of new drugs: Evidence from twenty-five major markets in the 1990s. Health Econ. 14: 269–292, 2005.
41.
AaltonenK.The impact of pharmaceutical cost containment policies on the range of medicines available and subsidized in Finland and New Zealand. Value Health13(1): 148–156, 2010.
NavarroV.Political power, the state and their implications in medicine. Rev. Rad. Polit. Econ.9(1): 61–80, 1977.
44.
TaylorS., and AshworthC.Durkheim and social realism: An approach to health and illness. In Sociological Theory and Medical Sociology, ed. ScamblerG.. Tavistock, London, 1987.
45.
DurkheimE.Professional Ethics and Civic Morals. Routledge, London, 1957.
46.
DurkheimE.The Elementary Forms of the Religious Life: A Study in Religious Sociology. George Allen and Unwin, London, 1915.
47.
DewK.Public health and the cult of humanity: A neglected Durkheimian concept. Soc. Health Illn. 29(1): 100–114, 2007.
48.
DewK.The Cult and Science of Public Health: A Sociological Investigation. Berghahn, London and New York, 2012.
49.
MaorM.A scientific standard and an agency's legal independence: Which of these reputation protection measures is less susceptible to political moves?Public Adm. 85(4): 961–978, 2007.
50.
LeeK.The Philosophical Foundations of Modern Medicine. Palgrave Macmillan, Houndmills, 2012.
