ABSTRACT
The cost per quality adjusted life year figure was used to rank the pairs in priority order, and it produced so many anomalies that the plan was nearly abandoned. The plan has appeared to work tolerably well since it began operating in February 1994. Ranking within categories was carried out by a mathematical procedure similar to the one used earlier but with less weight attached to cost and more to duration of benefit and quality of well-being. All consideration of quality of life had to be removed from the ranking process and that, combined with pressure from user groups, led to the upgrading of several controversial procedures. Clinicians may withhold covered services if they judge outcome to be poor, and that assessment could include quality of life considerations. New Zealand is working directly with clinicians to clarify when services should be provided and to whom.
