Implementing accountability for reasonableness – the case of pharmaceutical reimbursement in Sweden

2007 ◽  
Vol 2 (2) ◽  
pp. 153-171 ◽  
Author(s):  
SANDRA JANSSON
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Social Learning ◽  
Priority Setting ◽  
Relative Importance ◽  
Priority Setting Process ◽  
Structured Interviews ◽  
Accountability For Reasonableness ◽  
Setting Process ◽  
A Priority

AbstractThis paper aims to describe the priority-setting procedure for new original pharmaceuticals practiced by the Swedish Pharmaceutical Benefits Board (LFN), to analyse the outcome of the procedure in terms of decisions and the relative importance of ethical principles, and to examine the reactions of stakeholders. All the ‘principally important’ decisions made by the LFN during its first 33 months of operation were analysed. The study is theoretically anchored in the theory of fair and legitimate priority-setting procedures by Daniels and Sabin, and is based on public documents, media articles, and semi-structured interviews. Only nine cases resulted in a rejection of a subsidy by the LFN and 15 in a limited or conditional subsidy. Total rejections rather than limitations gave rise to actions by stakeholders. Primarily, the principle of cost-effectiveness was used when limiting/conditioning or totally rejecting a subsidy. This study suggests that implementing a priority-setting process that fulfils the conditions of accountability for reasonableness can result in a priority-setting process which is generally perceived as fair and legitimate by the major stakeholders and may increase social learning in terms of accepting the necessity of priority setting in health care. The principle of cost-effectiveness increased in importance when the demand for openness and transparency increased.

Receptive rationing: reflections and suggestions for priority setters in health care

2015 ◽  
Vol 29 (6) ◽  
pp. 701-710 ◽  
Author(s):  
Iestyn Williams
Keyword(s):  
Health Care ◽  
Priority Setting ◽  
Design Methodology ◽  
Decision Makers ◽  
Evidence Based ◽  
Priority Setting Process ◽  
Content Type ◽  
Setting Process ◽  
External Stakeholders ◽  
Health Care Priority Setting

Purpose – The purpose of this paper is to take forward consideration of context in health care priority setting and to offer some practical strategies for priority setters to increase receptiveness to their work. Design/methodology/approach – A number of tools and methods have been devised with the aim of making health care priority setting more robust and evidence based. However, in order to routinely take and implement priority setting decisions, decision makers require the support, or at least the acquiescence, of key external parties. In other words, the priority setting process requires a receptive context if it is to proceed unhindered. Findings – The priority setting process requires a receptive context if it is to proceed unhindered. Originality/value – This paper develops the concept of legitimacy in the “authorising environment” in priority setting and describes strategies which might help decision makers to create a receptive context, and to manage relationships with external stakeholders.

The process of updating the National List of Health Services in Israel: Is it legitimate? Is it fair?

2009 ◽  
Vol 25 (03) ◽  
pp. 255-261 ◽  
Author(s):  
Dan Greenberg ◽  
Miriam I. Siebzehner ◽  
Joseph S. Pliskin
Keyword(s):  
Health Services ◽  
Priority Setting ◽  
New Technologies ◽  
Time Frame ◽  
Priority Setting Process ◽  
Democratic Deliberation ◽  
Accountability For Reasonableness ◽  
Early Adoption ◽  
National Health Insurance Law ◽  
Setting Process

Objective:The Israeli National Health Insurance Law stipulates a National List of Health Services (NLHS) to which all residents are entitled from their HMOs. This list has been updated annually for almost a decade using a structured review and decision-making process. Although this process has been described in detail in previous papers, none of these have fully addressed legitimacy and fairness. We examine the legitimacy and fairness of the process of updating the NLHS in Israel.Methods:We assessed the priority-setting process for compliance with the four conditions of accountability for reasonableness outlined by Daniels and Sabin (relevance, publicity, appeals, and enforcement). These conditions emphasize transparency and stakeholder engagement in democratic deliberation.Results:Our analysis suggests that the Israeli process for updating the NLHS does not fulfill the appeals and enforcement conditions, and only partially follows the publicity and relevance conditions, outlined in the accountability for reasonableness framework. The main obstacles for achieving these goals may relate to the large number of technologies assessed each year within a short time frame, the lack of personnel engaged in health technology assessment, and the desire for early adoption of new technologies.Conclusions:The process of updating the NLHS in Israel is unique and not without merit. Changes in the priority-setting process should be made to increase its acceptability among the different stakeholders.

scholarly journals Tools for priority setting: lessons from South Australia

2006 ◽  
Vol 30 (1) ◽  
pp. 65 ◽  
Author(s):  
Sandra G Leggat ◽  
Wendy Scheil ◽  
Helena Williams ◽  
Kate Kerin
Keyword(s):  
Priority Setting ◽  
South Australia ◽  
Decision Makers ◽  
Advisory Group ◽  
Priority Setting Process ◽  
Clinical Issues ◽  
Department Of Health ◽  
Setting Process ◽  
A Priority

Background: This paper provides an overview of the process and tools used to develop and implement a priority setting framework for the Clinical Senate of South Australia. Established as a clinical advisory group to the Minister and Department of Health, the Clinical Senate recognised the need for an open priority setting process to fairly assign planning resources to the large number of clinical issues that needed to be addressed. Discussion: Using a workbook, developed from the literature and evidence related to priority setting, agreement was reached on the use, components and structure of the priority setting process. The final products included a Gap Finder Tool and a Priority Setting Framework. Summary: This paper describes the process used to develop the priority setting tools. Decision makers in other organisations can use similar processes and tools to develop or enhance their priority Setting processes.

scholarly journals Setting priorities in healthcare institutions: The case of McGill University Health Centre

2016 ◽  
Vol 5 (6) ◽  
pp. 38
Author(s):  
Onur Hisarciklilar ◽  
Atish Woozageer ◽  
Afrooz Moatari-Kazerouni ◽  
Andrea Schiffauerova ◽  
Vincent Thomson
Keyword(s):  
Priority Setting ◽  
Health Management ◽  
Health Centre ◽  
Priority Setting Process ◽  
Accountability For Reasonableness ◽  
Setting Process ◽  
Distribution Of Resources ◽  
Mcgill University ◽  
Demand For Health ◽  
Priority Setting Exercise

Priority setting is a decision-making process concerning the distribution of resources. The imbalance between allocated resources and public demand for health services as well as the inherent complexity of healthcare institutions are making priority setting one of the most challenging health management issues. Nevertheless, the priority setting processes and policymaking have not been studied very much at the hospital strategic planning level, i.e., the prioritisation of clinical activities. The purpose of this paper is to provide an evidence based case for improving the priority setting process in large hospitals. In a qualitative case study carried out at the McGill University Health Centre (MUHC), a priority setting exercise is described and the process is assessed in line with an accountability for reasonableness framework. Data collection involved in-depth, one-on-one interviews with key participants, review of key documents, and in-field observation. To assess the priority setting exercise, this paper compares the priority setting process against the five conditions of accountability for reasonableness, and identifies good practices and opportunities for improvement.

scholarly journals Major constraints and trends for common bean production and commercialization; establishing priorities for future research

2014 ◽  
Vol 32 (3) ◽  
pp. 423-431 ◽  
Author(s):  
Jesús José Rodríguez De Luque ◽  
Bernardo Creamer
Keyword(s):  
Common Bean ◽  
Priority Setting ◽  
High Yield ◽  
Future Research ◽  
Priority Setting Process ◽  
Setting Process ◽  
Production And Distribution ◽  
Use Efficiency ◽  
The Caribbean ◽  
Bean Research

In order to identify the principal constraints and trends for common bean production and commercialization and the priorities for future common bean research in Africa, Latin America and the Caribbean (LAC), a priority setting process was developed at the International Center for Tropical Agriculture (CIAT). The results suggested that the principal research included breeding and selecting for several traits, such as drought tolerance and water use efficiency, improved yields, and consumer acceptance (improved cooking time and desired texture after cooking). Additionally, the results of the priority setting process suggested that institutional measures are needed, such as improving formal seed production and distribution channels and the development of national and regional seed policies. On the other hand, the identified principal constraints included diseases, pests, and market constraints. Finally, the identified principal trends were: increase in demand and production, and development of high-yield varieties and improvement in nutritional quality.

scholarly journals Selecting topic areas for developing quality standards in a resource-limited setting

2019 ◽  
Vol 8 (1) ◽  
pp. e000491
Author(s):  
Roongnapa Khampang ◽  
Sarayuth Khuntha ◽  
Phorntida Hadnorntun ◽  
Suthasinee Kumluang ◽  
Thunyarat Anothaisintawee ◽  
...  
Keyword(s):  
Priority Setting ◽  
Quality Standards ◽  
Healthcare Services ◽  
Priority Setting Process ◽  
Deliberative Process ◽  
Mortality And Morbidity ◽  
Stakeholder Consultation ◽  
Healthcare Settings ◽  
Resource Limited ◽  
Setting Process

Variation in practices of and access to health promotion and disease prevention (P&P) across geographical areas have been studied in Thailand as well as other healthcare settings. The implementation of quality standards (QS)—a concise set of evidence-informed quality statements designed to drive and measure priority quality improvements—can be an option to solve the problem. This paper aims to provide an overview of the priority setting process of topic areas for developing QS and describes the criteria used. Topic selection consisted of an iterative process involving several steps and relevant stakeholders. Review of existing documents on the principles and criteria used for prioritising health technology assessment topics were performed. Problems with healthcare services were reviewed, and stakeholder consultation meetings were conducted to discuss current problems and comment on the proposed prioritisation criteria. Topics were then prioritised based on both empirical evidence derived from literature review and stakeholders’ experiences through a deliberative process. Preterm birth, pre-eclampsia and postpartum haemorrhage were selected. The three health problems had significant disease burden; were prevalent among pregnant women in Thailand; led to high mortality and morbidity in mothers and children and caused variation in the practices and service uptake at health facilities. Having agreed-on criteria is one of the important elements of the priority setting process. The criteria should be discussed and refined with various stakeholders. Moreover, key stakeholders, especially the implementers of QS initiative, should be engaged in a constructive way and should be encouraged to actively participate and contribute significantly in the process.

scholarly journals Accountability for Reasonableness, for Priority Setting and Resource Allocation: A Case Scenario

2015 ◽  
Vol 6 (2) ◽  
pp. 23-25 ◽  
Author(s):  
Zoheb Rafique
Keyword(s):  
Health Care ◽  
Resource Allocation ◽  
Developing Country ◽  
Priority Setting ◽  
Case Scenario ◽  
Scarce Resources ◽  
Accountability For Reasonableness

The purpose of this paper is to discuss the accountability for reasonableness and its four conditions. This explains the priority setting and resource allocation for scarce resources. In this article it is discussed that how the scarce resources in a developing country like Pakistan be allocated in health care. This is explained with the help of case scenario.

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