How do we achieve equitable access to medicine in New Zealand?
New Zealand’s current funding model prioritises upfront savings on the cost of medicines rather than downstream impacts on and costs to patients, whānau, and the wider health system and economy. Medicines are an important part of the health and disability support system, making a significant contribution to health outcomes for New Zealanders. They play a role in the healthcare of many people and are used extensively throughout the community and in hospital care settings.
Medicine access equity means that everyone should have a fair opportunity to access funded medicines to attain their full health potential, and that no one should be disadvantaged from achieving this potential. In this context, some groups may require additional support to access funded medicines than others. The causes of health inequities are complex, and solutions do not lie solely with the funding of medicines, or within the health system.
We know that there are barriers to equity at multiple levels including access barriers to health care (e.g. delayed access, costs, transport, family structure, expectations, beliefs), structural barriers such as how care is organised (e.g. accessing appointments, wait times, after hours advice and access, completing referrals) and the ability of providers to address a person’s needs (e.g. cultural safety and competency, health literacy, knowledge and skills, adherence)
PHARMAC has identified the primary drivers for change to eliminate inequities: availability (how PHARMAC makes and implements funding decisions so that everyone who is eligible can access funded medicines), affordability (reducing cost barriers for priority populations so that people can afford funded medicines), accessibility (ensuring people don’t face challenges getting to see a prescriber or to the pharmacy), acceptability (the ability of health services to create trust, so patients are informed and engaged enough to accept the medicines they’ve been prescribed); and appropriateness (the adequacy and quality of prescribing to ensure equitable health outcomes).
In 2019, The IQVIA International Comparisons of Modern Medicines report, commissioned by Medicines New Zealand, ranked New Zealand last for both access to funded medicines and pharmaceutical investment overall. The report showed of 304 modern medicines funded internationally between 2011-17, only 17 were funded in New Zealand. Between 2011 and 2020 Australia publicly funded three times more modern medicines than New Zealand and funded them twice as fast.
By failing to invest, New Zealand misses out on the savings to the health system and economic benefits that modern medicines offer. With this in mind, how do we make improvements to safeguard the future of our healthcare sector?