New Zealand consumers' perceptions of private insurance for pharmaceuticals.

Private insurance plays a minor role in paying for pharmaceuticals in New Zealand, despite controversy about access through the public health system. The present study examines New Zealand consumers' perceptions of private insurance for pharmaceuticals. A self-administered questionnaire was completed by 433 consumers at thirty pharmacies. The questionnaire included 18 questions on demographics, insurance status, perceptions of private insurance for pharmaceuticals and confidence in the public health system. Forty six percent of respondents had private health insurance. Respondents were more likely to have private health insurance as household income increased, and confidence in the public health system decreased. (Over two thirds of respondents were either confident or very confident in the public health system). Nineteen percent had private health insurance for pharmaceuticals, and the likelihood was not affected by household income or confidence in the public health system. Sixty one percent believed private insurance for pharmaceuticals would increase availability and affordability of pharmaceuticals. However, just over half were willing to pay for private insurance for pharmaceuticals. Of these, over two thirds were only willing to pay $20 per year or less. New Zealand pharmacy consumers' willingness to pay for private insurance for pharmaceuticals is very low.

Key informants' perceptions of how pharmac operates in New Zealand.

OBJECTIVES: The aim of this study is to examine key informants' perceptions of how the New Zealand Pharmaceutical Management Agency (PHARMAC) operates in New Zealand. METHODS: We carried out qualitative analysis of semi-structured interviews with key informants. We obtained ethics approval from the University of Otago School of Pharmacy, and all participants gave informed consent. We digitally recorded the interviews, which were then transcribed, and coded in NVivo. The data were analyzed by theme using constant comparison methods. Twenty informants who had previously published research or commentary on New Zealand's access to medicines, acted as spokespersons for interest groups, or held positions that gave them key insights into New Zealand's medicines system agreed to participate. Informants were purposefully selected to ensure a wide range of views, including five people working in medicine, four in pharmacy, three Members of Parliament from different parties, and two each from PHARMAC and the pharmaceutical industry. RESULTS: Respondents saw PHARMAC as an organization that contained medicine costs effectively, was politically neutral, and resistant to lobbying. It enjoyed broad political support and, with extremely rare exceptions, had been allowed to carry out its functions independently regardless of who was in government. As a result of this political stability, the relationship between PHARMAC and the pharmaceutical industry has been improving. CONCLUSION: PHARMAC's longevity and increasing influence are largely due to political choices made to prioritize containing pharmaceutical expenditure and to respecting PHARMAC's independence. This may be difficult to replicate in other countries.

A 3-dimensional view of access to licensed and subsidized medicines under single-payer systems in the US, the UK, Australia and New Zealand.

INTRODUCTION: Patients' access to medicines can be profoundly affected by the decisions made by medicine licensing bodies and public reimbursement agencies. The present study compares access to licensed and subsidized medicines under a single-payer system in each of the US, the UK, Australia and New Zealand (NZ). These systems are the US Department of Veterans Affairs National Formulary (VANF), the UK NHS for England and Wales, Australian Pharmaceutical Benefits Scheme (PBS) and NZ's Pharmaceutical Management Agency (PHARMAC). The VANF, PBS and PHARMAC all use positive lists of medicines that are subsidized, along with pharmacoeconomic analysis and price negotiations with suppliers. The NHS uses a negative list of medicines that are not to be subsidized, along with pharmacoeconomic analysis of a small number of medicines and caps on manufacturers' profits. OBJECTIVE: Our objective was to compare licensed and subsidized medicines in terms of the following: (i) total numbers of entities (unique Anatomical Therapeutic Chemical [ATC] codes); (ii) times since first registration (age) of the entities; and (iii) numbers of innovative entities. METHODS: This was an observational study in order to test pre-defined hypotheses. All products listed in a major prescribing reference in each country were included in the study. All products were classified by ATC code and their registration dates recorded. Products were collapsed by ATC code to determine 'best-case' licensing and subsidy for each entity, along with the date of first registration. Innovative entities selected for 'fast-track' approval by the US FDA or as a 'breakthrough or substantial improvement' by the Canadian Patented Medicines Prices Review Board were identified. Results were verified by a sensitivity analysis that excluded entities only available in injectable formulations (as these may not always be listed in general prescribing references), and by a parallel analysis done by active agent rather than ATC code. RESULTS: Of the 918 entities and 64 innovative entities licensed in the US, 505 and 20, respectively, were subsidized by the VANF. In the UK, this was 1020 and 58 (1016 and 58 NHS subsidized); in Australia, this was 879 and 49 (567 and 30 PBS subsidized); and in NZ, this was 765 and 39 (503 and 19 PHARMAC subsidized). With the exception of the UK, entities licensed in the US were newer than elsewhere. The median ages were as follows: 6607 days in the US (VANF subsidized 8203 days; p < 0.001); 7319 days in the UK (NHS subsidized 7319 days; p = 0.903); 7795 days in Australia (PBS subsidized 8065 days; p = 0.406); and 8936 days in NZ (PHARMAC subsidized 10 724 days; p < 0.001). NHS subsidized entities were newer than elsewhere. VANF and PHARMAC subsidized entities were significantly older than licensed entities in their respective countries. CONCLUSION: The single-payer systems examined differ in the number and age of licensed and subsidized entities, along with access to innovative entities. The NHS subsidized the most entities, the newest entities and the most innovative entities. NZ's PHARMAC system subsidized the fewest and oldest entities, and the fewest innovative entities. The VANF and PBS consistently fell between the other two systems in terms of the number of subsidized entities, age of subsidized entities and number of subsidized innovative entities.

Coverage and accuracy of ethnicity data on three Asian ethnic groups in New Zealand.

OBJECTIVE: Detecting and eliminating ethnic disparities in access to and outcomes of healthcare relies on accurate ethnicity recording. Studies have shown that there are inaccuracies in ethnicity data in New Zealand and elsewhere. This study examined coverage and accuracy of ethnicity data for three Asian ethnic groups. METHODS: Student researchers from, or with links to, the ethnic groups concerned worked with communities to recruit participants. Names and dates of birth, length of residence in New Zealand and immigration status were recorded. Names and dates of birth were sent to the New Zealand Health Information Service, which attempted to link them with National Health Index ethnicity data. RESULTS: Only 72% of participants could be linked to an NHI number, and only 48% of those had their ethnicity recorded accurately. Linkage odds were lower for older people, and accuracy was higher for Chinese people compared to the other ethnicities. Length of residence and immigration status did not affect either coverage or accuracy. CONCLUSION: Most participants who could be linked had their ethnicity recorded in the broader category of "Asian", but accuracy was poor at the sub-group level. IMPLICATIONS: Extreme caution should be applied when examining data about sub-groups within the 'Asian' category.

Access to children's medicines in the United Kingdom, Australia and New Zealand in 1998, 2002 and 2007.

OBJECTIVE: To describe the listing of prescription entities (unique active agents only available on prescription) in standard reference texts that were licensed for children (0-18 years), in dosage forms suitable for children, and subsidised (Government funded) for children. Setting The United Kingdom, Australia and New Zealand in 1998, 2002 and 2007. METHOD: A review of data from 1998, 2002, and 2007 using standard prescribing and subsidy reference sources in each country. The study examined all prescription entities, orally available entities, and entities newly licensed for children 2002-2007. MAIN OUTCOME MEASURE: Changes in the number of prescription entities that were licensed, suitably formulated and subsidised for children over the period. Results The United Kingdom had the highest number of prescription entities (1149 in 1998; 1049 in 2007), entities licensed for children (677; 564), entities suitably formulated for children (791; 676), and entities licensed for children and subsidised (677; 562) over the period. However, the numbers and proportions of entities licensed for children and suitably formulated for children decreased over the period of the study. New Zealand and Australia had lower numbers throughout the period, but the number of entities licensed for children (New Zealand 319-450, Australia 288-466) and entities licensed for children and subsidised (New Zealand 245-288, Australia 155-254) increased over the period. CONCLUSION: Over the period of the study, there was a decrease in listed prescription entities that were licensed for children in the United Kingdom, but an increase in Australia and New Zealand. There were considerably fewer entities licensed, suitably formulated and subsidised for children than for adults at all three time points and in all three countries. This reinforces the need for the current initiatives to improve access to medicines for children.

The impact of pharmaceutical cost containment policies on the range of medicines available and subsidized in Finland and New Zealand.

OBJECTIVE: To identify differences in the range of medicines available and subsidized for ambulatory care in Finland and New Zealand. METHODS: Medical entities listed in national product information sources and their subsidy statuses were compared. The number and overlap of entities available and subsidized were determined. Differences in the age of subsidized medicines were compared using the date of first registration. Differences in licensing delays were compared using a selection of new innovative medicines that provide health gain. RESULTS: Within the inclusion criteria, 779/763 entities were available and 495/471 subsidized in Finland/New Zealand, of which around 30% (30.9% Finland, 29.5% New Zealand) were not available and approximately 40% (41.4% Finland, 38.4% New Zealand) not subsidized in the other country. The proportion of fully subsidized entities was higher in New Zealand (86.2%/29.1%). The entities only subsidized in New Zealand were significantly older than those only subsidized in Finland and the share of licensed and launched innovative medicines was significantly smaller in New Zealand. The differences were equally distributed across the therapeutic groups but clinically relevant differences were rarely found. CONCLUSIONS: In New Zealand, medicines are heavily subsidized across therapy groups, but those uniquely subsidized were older entities. In Finland, more "newer" medicines are subsidized and available, but the level and coverage of subsidy is lower and thus, the patient cost burden is higher. The cost containment policies adopted seem to affect patients' access to medicines mainly by availability in New Zealand and by affordability in Finland.