DECISION-MAKER'S PERCEPTIONS OF ACCESS TO HIGH COST DRUGS (HCDS) IN PUBLIC HOSPITALS IN AUSTRALIA

OBJECTIVE: To investigate the perceptions, concerns and attitudes of decision-makers regarding access to HCDs in public hospitals. METHODS: In-depth, semi-structured interviews were conducted with public hospital senior managers, directors of pharmacy and senior medical doctors in a Sydney Area Health Service. Topics for the interviews included the decision-making process and associated problems and solutions to matters of access to HCDs. Interviews were audiotaped, transcribed verbatim, thematically content analyzed and coded using NVivo software. RESULTS: Data analysis identified a number of emerging themes. Decision-makers perceived health care system funding models as obstacles to equity of access to HCDs. They were concerned that there were inequities in decisions for individual patients depending on public or private sector hospital status. Tertiary public hospitals were perceived to be at the 'cutting edge' and therefore were required to fund new, expensive drugs. A major concern for respondents was that, as a consequence, this meant prioritizing between patient groups and individual cases. "Why is one patient group more important than another patient group and how do we decide which drugs should be available to each patient?" The majority of respondents identified equity problems in access to HCDs, however they had difficulty in identifying solutions. Respondents described that, besides safety, effectiveness, efficacy and cost, ethical principles should be borne in mind when deciding whether a HCD should be available in a public hospital. Most wanted a transparent, accountable, evidence-based decision-making process. CONCLUSION: The preliminary results of this study suggest that decision-makers were concerned about the equity of access to HCDs in public hospitals. They were concerned regarding the process for decision-making and the outcomes of these decisions. Further research will explore the views of the public regarding funded access to HCDs.