Herceptin funding increase turned down

[Robert Taylor]

Imagine how much money would become available for such things if we simply "made families work for themselves"

Exactly. And if we had less civil servants that were put back into the real workforce to actually do something productive.

[98tls]

Exactly. And if we had less civil servants that were put back into the real workforce to actually do something productive.

Whilst at it we could make the army of "wouldnt get a job anywhere else" winz,whinge or whatever its called these days work on a contract basis,nobody gets a job then nobody gets paid for sitting round in Warehouse quality suits all day pretending to be of use to society in general.

[Mully]

That's precicely what the decision is. No matter what the budget is, no matter how generous, there will always be a procedure or medicine that we can't afford. The choice will always be "If we fund this then we can't fund a medicine which provides better returns for the same cost".

You might look at increasing the health budget, (and we have, it's a higher percentage of GDP than ever before), but there'll still be things we can't afford, there always will be.

Hi Ocean,

Not trying to shit-stir, but I understood that Pharmac have been very proud of the fact that for several years they have come under budget. Crowed about it wouldn't be a bad choice of words.

Seems Pharmac's manager's targets are being set wrong.

[kiwi cowboy]

i bet if any of the friggen hippocrites in the behive got this cancer the rules would change but they would get the full 12 month on us taxpayers anyway mind you helen is safe she da man

[98tls]

Surprised to be honest that Maori women havent demanded they get it for zip because without doubt there wish would be granted considering we are approaching an election,before all the "racist" shit starts i am simply stating my observations of late.

[Ocean1]

Seems Pharmac's manager's targets are being set wrong.

Dunno, not privy to the details.

No doubt there's health money being spent unwisely, no doubt at all.
But the fact remains that given any limit on resources there must be limits on spending.

So by all means rant about wasted money, start with some of the more outrageous compliance cost, but also recognise that you will never cure everyone of everything.

If you're passionate enough about it then sort yourself out a medical degree, start a practice, charge as little as you can afford. Fund whatever research takes your fancy. General bleating about available funds migh feel good but you might as well bitch about the weather, that's not going to change either.

[Nasty]

But ...



I appreciate this is a tough decision and I'm glad I didn't have to make it - I'm not sure what approach I'd take, even. But they guy is out-and-out saying it is not about the money. So, do you have any basis for calling him a liar?

Ok .. .so I take it from this angle - it is closer example of NOT ABOUT THE MONEY that I have seen. I have multiple sclerosis .. its a degenerative disease and over the years they have developed drugs for it. these drugs cost around $26000 per year ... every year .... they are to stop the degeneration ... or reduce the amount of times a person comes out of remission. The level of entry for this drug in NZ is set too high ... the level of exit is set at a stupid level where the drug is proven to be of no benefit. If I was in Australia/UK or USA I would have had the drugs 11 years ago with diagonosed ... but not in NZ .. wait till more damage is done and then give you something that may/should have prevented it getting so bad in the first place.

IT is about the money ... for herceptin its the same thing. Give a little and say that the rate of death is lower... but give a longer period and EARLIER in the disease and the recovery rate is huge. Its not only about the length of time its about WHEN they are given the drugs.

[candor]

Its not actually about the money - heaps is spent - it's about novel experimental stupid redirection of it under a big Govt multi sector experiment. Treasury has monitors crusing round in different Govt buildings eg Wellington hospital. Some cursory research turns up the following.

Herceptin and Road Safety Trials

The Judicial Review Panels decision, affirming the propriety of the New Zealand Government testing short term breast cancer treatment with Herceptin as opposed to funding full treatment courses, wasn't based on full information and as such bodes badly for similar appeals in relation to road safety decisions.

In both health and road safety areas policy trials of great import and significant risk are being run down under, under the umbrella of the State Pathfinders project (applied macro economic theory pilot).

The abnormal resource allocation decisions being made in the NZ health and road safety areas come back to State Service "Outputs" (prioritised State activities) being tied to a maximum of only 3 focuses being permitted for any Government Department, as per the Pathfinders policy project manuals and guides for bureaucrats.

The NZ State Services Commission publication "Pathfinder Building block 1: Identifying Outcomes" specifies the “vital few” outcomes as the core (3 or less) outcomes that:
· are well aligned with the agency’s (or business unit’s) mission or purpose;
· are tangibly linked to outputs and inputs (the things an agency manages);
· can be measured using reliable data, obtainable at a reasonable cost.

In Road Safety management the "vital few" issues that attract Treasury funding (without great impact) are reduced speed, drink driving and seatbelt disuse, and the requirement is to "supress" other issues. For the Health portfolio the vital few have been defined within State Service Commission Documents on the pathfinders website as reduced smoking, cardiovascular disease and diabetes. Breast or any cancer is not a key performance indicator - so obviously gets short shrift..... 9 weeks or whatever of treatment just to be seen to be doing something!

"Outputs" (per pathfinders) are defined as the results targeted from various efforts to achieve the final outcomes also known as the "vital few." For example, lower speeds on highways or lower average fat consumption will be achieved. Anecdotally, lobby groups are claiming New Zealand has seen excess effort put into "vital few" related outputs - while other obvious priorities and past priorities are relegated to the scrap heap.

The covering letter to Chief Executives for the 2003/04 roll-out of State Owned Enterprises states “you will not be held accountable for achieving outcomes, you will be held accountable for 'managing for outcomes’”. The covering letter is explicit about the accountability of chief executives: “you will still be held accountable for delivering outputs and for altering your mix of outputs as circumstances dictate”.

According to the State Services Office website, Chief Executives will be held accountable for the delivery of outputs, and for the selection of outputs, without compromising Ministerial expectations. They have no power to select the vital few priorities, and are therein slaves to Treasury monitors. Treasury Pathfinder papers give Officials a "bum steer" by advising that the selected outcomes should always support critical business and resource decisions.

It seems the dominance of the "vital few" across many sectors is creating an overabundance and resource wastage in targeting some issues, while others that are quite deserving have had the purse strings pulled so tight as to be obviously unjust.

The Pathfinders website advises that mistakes may be made but should be viewed as a learning experience . Prime examples of the Pathfinder folly come from the health and road safety arenas. The odd approach is often exemplified in such cases as Government failing to fund realistic courses of herceptin treatment (seen as locking the stable after the horse has bolted), while millions are spent providing free nicotine chewing gum to smokers with no diagnosed cancerous or other condition.

The high potential for misfired and unjustly apportioned funding, as part and parcel of the Pathfinders project, seems prima facie to reflect policy possibly in breach of NZ's Bill of Right Act; on "right to life" or "rights not to suffer scientific experimentation" grounds.

I believe the herceptin heroines should bring a human rights based case given the judicial review looked at an irrelevancy - that being a decision made by Pharmac - that was not really made by Pharmac.... given it's decisionmaking power has parameters placed around it by the Pathfinder experiment.

What is our Govt getting for selling our souls to be economic research guinea pigs? And why have I recieved 3 enormous bundles of nicorette worth hundreds of dollars with just a few 0800 quitline ph calls. I'd gladly return them or pay my own way if the coin could be redirected to those who actually HAVE cancer. It's all about as inefficient as communist Europe The Herceptin wanters like a lot of road toll victims are clear as day being killed by economic experiments signed off by I wonder who.

[Ocean1]

Yes. Otherwise known as tunnel vision, and if you checked you'd see plenty of evidence of similar behaviour elsewhere.

P'raps those who consider policy a useful management concept can't handle more than three problems at once.

Bloody glad they're not operational...