Funding and access to high cost medicines in public hospitals in Australia: decision-makers' perspectives.
OBJECTIVE
To investigate the perceptions, concerns and attitudes of decision-makers regarding access to high cost medicines (HCMs) in public hospitals.


METHODS
In-depth semi-structured interviews were conducted with 24 decisions-makers (executive directors of hospitals, area health service managers, directors of hospital pharmacy departments and senior medical doctors) in a Sydney Area Health Service. The interviews were digitally recorded and transcribed and analysed using a modified grounded theory approach.


RESULTS
Decision-makers perceived health care system funding models as obstacles to equity of access to HCMs. They were concerned that there were inequities in decisions for individual patients according to public or private sector status. A major concern for respondents was the lack of consistency in decision-making about funding for HCMs. Respondents described that besides safety, efficacy, effectiveness and cost, ethical principles should be borne in mind when deciding whether a HCM should be available in a public hospital. Most wanted a consistent, transparent, accountable, evidence-based decision-making process.


CONCLUSIONS
The results of this study suggest that decision-makers were concerned about the equity of access to HCMs in public hospitals and wanted an explicit, systematic process to allocate resources to HCMs.
Gallego
Gisselle
G
Centre for Health Economics Research and Evaluation (CHERE), University Technology Sydney, Australia. gisselle.gallego@chere.uts.edu.au
Taylor
Susan Joyce
SJ
Brien
Jo-Anne Elizabeth
JA
D000288:Administrative Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D002017:Budgets; D003627:Data Interpretation, Statistical; D003659:Decision Making, Organizational; D016527:Drug Costs; D006297:Health Services Accessibility; D006779:Hospitals, Public / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D009517:New South Wales; D004364:Pharmaceutical Preparations / Q000191:economics*; D040841:Resource Allocation
D004364:Pharmaceutical Preparations