Providing unfunded cancer drugs in public hospitals could undermine Pharmac's negotiations for the purchase of some medicines, the drug-buying agency says.
This could effectively reduce the value that could be obtained from public medicine funding, Pharmac says in its submission to the Otago and Southland district health boards on their "Bridging the Gap" consultation.
The full list of 100 submissions shows that those who take issue with the proposal to offer public patients unfunded drugs include Pharmac, two of Otago-Southland's public health physicians and former board member Mary Gamble.
Overall, 58% of the responses were in favour and 38% against.
Pharmac chief executive Matthew Brougham said in his submission that previous experience with medicines funded under the "exceptional circumstances" rules suggested that where suppliers were generating sizeable returns through hospital sales, they were reluctant to negotiate agreements with Pharmac at a lower price.
"This would impact on those people who would benefit from the medicines but cannot afford top-up treatments."
Ultimately, all medicine users would be affected, as the value for money from the medicine budget overall would be reduced.
Approached for extra comment, Mr Brougham said in a statement the purpose of the submission was to highlight a potential issue that might arise should the policy be implemented nationally.
He anticipated if there was to be any national decision there would be further opportunity to consider the broader issues.
Pharmac recognised a pilot was being proposed for the Otago-Southland region.
In the report on the submissions, board management points out the treatments which would be involved were already available in the Auckland area and some patients from the South already travelled there for private treatments.
It was considered unlikely that providing access to the treatments in Otago and Southland would have a destabilising effect on the public health funding structure or any significant effect on Pharmac.
Mr Brougham's submission said provision of privately funded medicines in a public setting could also give mixed messages to patients about the overall benefits of treatments, which could undermine confidence in Pharmac decisions.
Public hospital administering of a drug might be interpreted as an endorsement of its effectiveness.
This could cast doubts on Pharmac's judgement if its analysis showed a drug offered limited apparent benefit over other funded treatments or that side effects were too great.
The New Zealand Nurses Organisation recommended the first stage in the development of a national strategy for faster, fairer access to new treatments be to increase Pharmac's budget; streamline the processes involved in the introduction of innovative treatments; and spend more on health generally.
Otago-Southland public health physicians Dr Marion Poore and Dr Derek Bell and board nurse director Adele Knowles were against the proposal going any further.
They considered it was likely to result in inequity, would further disadvantage the most vulnerable people and was counter to current health policy.
It could also result in duplicate services and confusion for the workforce, who would be providing free services to some patients, while others paid for them.
Former board member Mary Gamble, now resident in Ireland, objected to the proposal, saying the mix of private and publicly funded patients in the same hospitals in Ireland was a mess.
On some parts of the balance sheet there would be financial gains, but these would come at the expense of the health and dignity of the less well off, she saidThe system she described appeared to differ from the pilot being suggested by the boards.
Several submissions, including that of the Otago-Southland division of the Cancer Society, said the issues raised in consultation should be dealt with nationally, as they had implications for all public hospitals.
The Medical Association agreed, asking that before the matter went any further it be considered by the new National Health Board.
Association of Salaried Medical Specialists executive director Ian Powell also sought national consideration of the issue, and said he would be communicating directly with Health Minister Tony Ryall.
Those in favour of the top-up treatments included oncologist Dr David Perez, who said it was difficult to pre-judge who would wish to pay for therapies. Some people with limited finances managed to find the money from friends, relatives or with community support.
He said he would support the proposal only if privately funded treatments did not get priority over or displace public patients.
A submission by oncology nurses from the Otago board were in favour in principle, but raised questions about the practicalities involved.
They also asked if providing private treatments only at Dunedin Hospital might lead to unfair access to services through the Southern Blood and Cancer Service.
A Gore cancer patient referred to difficulties caused when Pharmac funded fewer treatments than were "internationally recognised".
The additional expense of having to use the private system and travelling to a private chemotherapy centre could be avoided if the drug could be bought by, and administered through the public system.
One unnamed supporter of the proposal likened the proposal to air travel, where people "have no problem with the concept of economy, business and first class".
The crew and destination remained the same, safety was ensured and everyone benefited by the extra money paid by the first class passengers.
The only possible losers would be the providers of private health care, the submission said.
