Stakeholders score PHARMAC's annual review
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"Very poor, could do better"
The RMI has long been concerned that the only performance
indicator for the agency charged with the procurement of
medicines for New Zealanders, PHARMAC, is whether it manages
its purchases of medicines within the allocated budget.
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13 years of PHARMAC |
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There are no accountabilities relating to the level of
access to medicines achieved and no measures of health outcomes
- good or bad.
Dr Pippa MacKay, the chair of the Researched Medicines Industry
said "the situation is a scandal and is a direct result
of PHARMAC being set up to take the flak over the failure
by the Government and the DHBs to provide sufficient funding
to ensure that New Zealanders have similar access to modern
medicines as do citizens in other developed countries.
"No agency, public or private, should have such loose accountabilities,
especially when they are dealing with both vulnerable ill
people as well as many millions of dollars" she said.
Every year a glossy publication is released lauding PHARMAC's
performance - measured against an un-quantified contribution
to 'health outcomes' and today PHARMAC has again published
its own self-congratulating document.
The RMI thinks New Zealand deserves a more objective assessment
of the Government policy delivering medicines to New Zealanders
over the past year. This e-zine contains an objective review,
based on responses from PHARMAC's key stakeholders; the
general public, general practitioners and pharmacoeconomists.
In each case the report draws on research or material that
was published during the 2005/06 year - so it is directly
comparable.
These stakeholders rate PHARMAC's performance as 'very poor,
could do better'.
"This is more an indictment on the policy and funding levels
PHARMAC has to operate under than on the agency itself,"
Dr MacKay observed.
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General public says "thumbs down"
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Insufficient funding and PHARMAC's consequent
medicines rationing policies have resulted in an 8% deterioration
in PHARMAC's net favourable rating (total favourable less
total unfavourable) which fell from -11% last year to -19%
this year. This means that almost one fifth (19%) of the
population in this survey have a more unfavourable opinion
of PHARMAC than those who have a favourable opinion. This
is an increase of 8% from last year when the corresponding
figure was 11%.
This was reported in a September survey by UMR Research
Ltd which repeated a similar survey reported in February
2006.
The comparisons show an alarmingly low level of public confidence
in this crown body and the policies it administers.
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Public opinion of PHARMAC has deteriorated over the past
year. There was a 4% decline from 17% to 13% of those who
have a favourable opinion and a 4% increase from 28% to
32% among those who have an unfavourable opinion of PHARMAC.
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There has been a significant increase in those who say
New Zealanders have worse access to new medicines than countries
like Australia. Last year, 50% said New Zealanders have
worse access, but this year 59% held that view.
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There has been a slip in confidence that PHARMAC strikes
the right balance between meeting healthcare needs and what
New Zealand can afford. There was a fall from 20% to 19%
among those who had total confidence in PHARMAC to strike
the right balance and an increase from 28% to 30% among
those who are not confident in it doing so.
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Net confidence in PHARMAC's ability to strike the right
balance between meeting health care needs and what New Zealand
can afford fell 3% to -11%.
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Support for an independent review of PHRMAC remains high
with 69% in support of a review this year compared with
68% last year.
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The top three reasons those who have an unfavourable opinion
of PHARMAC cite for their views are:
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Won't fund/too slow to fund new medicines or some medicines
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Subsidy of essential medicines as too low or medication
is too expensive or lack of choice
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Too focused on saving money.
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| Source: The New Zealand Pharmaceutical Industry Taskforce.
PHARMAC favourability and access to/confidence in medicines/health
care. UMR Research Ltd, September 2006 |
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Doctors
score performance as 'poor,
could do a lot better'
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Clinicians too have huge reservations about a policy
that deprives New Zealanders of medicines that are
normally available in other countries.
Two independent published reports score PHARMAC's
performance over the same period as its review released
today as 'very poor, could do a lot better'," said
Dr Pippa MacKay, the chair of the RMI and a general
practitioner.
The reports are the New Zealand Medical Journal's
special series on PHARMAC during the year to June
2006 and a UMR qualitative study on clinicians'
views on PHARMAC, November 2005.
71% of NZ general practitioners and specialist respondents
rated PHARMAC poor with respect to it ensuring that
New Zealanders' access to medicines is as good as
countries like Australia, the UMR survey found.
An overwhelming majority of respondents said they
wanted PHARMAC to be reviewed and believed increased
funding of medicines should be a high priority for
the Government.
Respondents supported a general review of PHARMAC
because they believed it is too budget-focussed
rather than patient-focussed and that its decision-making
lacks transparency.
The NZMJ series of 20 contributed peer reviewed
articles elaborated on several key themes surrounding
the government's drug procurement agency. And, none
of them were complimentary. These themes included:
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Significant delays in meeting patient
needs |
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Barriers to prescribing |
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Poor quality generics and the consequences
of sole supply arrangements |
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Decisions contrary to international
guidelines and evidence |
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Denied or reduced access increasing
costs in other health areas |
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Decisions contrary to Government policy
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Pippa MacKay said PHARMAC's annual review should
have taken account of both the NZMJ series and the
UMR research.
"Both are objective, and reflect very clearly the
perceptions of a major group of stakeholders in
the medical sector who work daily with the problems
the system causes.
"Rather than applauding its ability to act within
its restricted budget, PHARMAC should complain about
the funding and policy regime that rations the availability
of modern medicines needed by New Zealand patients,"
she said.
The NZMJ series was entirely the initiative of the
NZMJ and was undertaken because of the increasing
concern amongst the medical profession in New Zealand
about the adverse effect PHARMAC has on the health
of New Zealanders through the restriction on the
availability of medicines.
The UMR research was a mail survey of 529 medical
practitioners whose primary employment capacities
are as GPs, specialists or medical officers. 529
of 1500 postal surveys were returned. The report
was conducted in September/October 2005.
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| Source: Qualitative Study on Clinicians' views
on PHARMAC. UMR Research Ltd, November 2005 |
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National
Medicines Strategy
So, PHARMAC's performance over the past year did not meet the
expectations or hopes of its stakeholders.
"Is this altogether PHARMAC's fault? No we don't think so,"
Dr Pippa MacKay, chair of the Researched Medicines Industry
commented.
"While PHARMAC does play hardball with the industry and patient
groups, it is a pretty convenient model for government, the
DHBs and officials.
"The PHARMAC model removes any accountability for provision
of medicines from the Minister, Parliament can't scrutinise
its operational activities, and the DHBs who hold the budget,
appear to have no accountability to either PHARMAC or the Minister.
"And worse, PHARMAC's only performance measurements are a vague
tilt toward unspecified 'improved health outcomes' and ensuring
the annual budget is not exceeded. That is hardly challenging
and neither is it sound management. "In terms of governance
this is a very poor example of stewardship of taxpayers' dollars
and care for New Zealanders who need medicines," she said.
"Peter Dunne's work on the National Medicines Strategy offers
a huge opportunity to resolve this matter by putting transparency
and integrity into the processes around selection of potential
medicines to be added to the Schedule and the procurement of
them. Separation of clinical and financial decisions is essential."
The RMI believes that this new strategy can, if carefully designed,
deliver a model of medicines selection and procurement which
will achieve these fundamental principles without dismantling
PHARMAC and creating a new bureaucracy.
"We are eagerly awaiting the consultation document and to working
with Minister Dunne to ensure that we end up with a patient
focused strategy which ensures that New Zealanders have at least
comparable access to medicines as do citizens in other OECD
countries," Dr MacKay said.
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Fact 1: More medicines made available for Aussie patients
PHARMAC’s annual review says it has subsidised 14 new medicines
in 2005/06 but this is still very low compared to other countries.
For example, in the six years to May 2006, Australia listed
78 new innovative medicines while NZ has only funded 20 of these.
Source: “Access by patients in New Zealand to innovative
new prescription-only medicines; how have they been faring in
recent times in relation to their trans-Tasman counterparts”
was written by Michael Wonder, Senior Health Economist, Australia.
2006
Fact 2: Aussies spend more per capita on medicines
The New Zealand government tends to spend between 40 and 50%
less than the Australian government on medicines.
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The Australian PBS current spend is $7.1 billion or around
$355 per person.
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PHARMAC spent $563.45million last year, or around $137
per person.
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