Funding and access to high cost medicines in public hospitals in Australia : decision-makers' perspectives

Aim: 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.