scholarly journals Moving Towards Accountability for Reasonableness – A Systematic Exploration of the Features of Legitimate Healthcare Coverage Decision-Making Processes Using Rare Diseases and Regenerative Therapies as a Case Study

2019 ◽  
Vol 8 (7) ◽  
pp. 424-443 ◽  
Author(s):  
Monika Wagner ◽  
Dima Samaha ◽  
Roman Casciano ◽  
Matthew Brougham ◽  
Payam Abrishami ◽  
...  
Keyword(s):  
Decision Making ◽  
Stakeholder Participation ◽  
Life Cycle Approach ◽  
Decision Criteria ◽  
Accountability For Reasonableness ◽  
Coverage Decision ◽  
Healthcare Coverage ◽  
Decision Making Processes ◽  
Regenerative Therapies

Background: The accountability for reasonableness (A4R) framework defines 4 conditions for legitimate healthcare coverage decision processes: Relevance, Publicity, Appeals, and Enforcement. The aim of this study was to reflect on how the diverse features of decision-making processes can be aligned with A4R conditions to guide decision-making towards legitimacy. Rare disease and regenerative therapies (RDRTs) pose special decision-making challenges and offer therefore a useful case study. Methods: Features operationalizing each A4R condition as well as three different approaches to address these features (cost-per-QALY-focused and multicriteria-based) were defined and organized into a matrix. Seven experts explored these features during a panel run under the Chatham House Rule and provided general and RDRT-specific recommendations. Responses were analyzed to identify converging and diverging recommendations. Results: Regarding Relevance, recommendations included supporting deliberation, stakeholder participation and grounding coverage decision criteria in normative and societal objectives. Thirteen of 17 proposed decision criteria were recommended by a majority of panelists. The usefulness of universal cost-effectiveness thresholds to inform allocative efficiency was challenged, particularly in the RDRT context. RDRTs raise specific issues that need to be considered; however, rarity should be viewed in relation to other aspects, such as disease severity and budget impact. Regarding Publicity, panelists recommended transparency about the values underlying a decision and value judgements used in selecting evidence. For Appeals, recommendations included a life-cycle approach with clear provisions for re-evaluations. For Enforcement, external quality reviews of decisions were recommended. Conclusion: Moving coverage decision-making processes towards enhanced legitimacy in general and in the RDRT context involves designing and refining approaches to support participation and deliberation, enhancing transparency, and allowing explicit consideration of multiple decision criteria that reflect normative and societal objectives.

PP149 Features Of Accountable And Reasonable Processes For Coverage Decision-Making

2018 ◽  
Vol 34 (S1) ◽  
pp. 125-125
Author(s):  
Monika Wagner ◽  
Dima Samaha ◽  
Roman Casciano ◽  
Matthew Brougham ◽  
Charles Petrie ◽  
...  
Keyword(s):  
Decision Making ◽  
Stakeholder Participation ◽  
Allocative Efficiency ◽  
Legal Framework ◽  
Quality Adjusted Life Year ◽  
Decision Criteria ◽  
Accountability For Reasonableness ◽  
Coverage Decision ◽  
Explicit Consideration ◽  
Definition Of

Introduction:The Accountability for Reasonableness (A4R) framework addresses the legitimacy of coverage decision processes by defining four conditions for accountable and reasonable processes: Relevance, Publicity, Appeals, Implementation. Cost-per-quality-adjusted life year (QALY) and multicriteria-centered processes may have distinct implications for meeting A4R conditions. The aim of this study was to reflect on how the diverse features of decision-making processes can be aligned with A4R conditions to guide legitimized decision-making. Rare disease and regenerative therapies (RDRTs) pose special decision-making challenges and offer a useful case study.Methods:To support reflection on how different approaches address the A4R conditions, thirty-four features operationalizing each condition were defined and organized into a matrix. Seven experts from six countries explored and discussed these features during a panel (Chatham House Rule) and provided general and RDRT-specific recommendations for each feature. Responses were analyzed to identify converging and diverging recommendations.Results:Regarding Relevance, panelists highlighted the importance of supporting deliberation, stakeholder participation and grounding coverage decision criteria in the legal framework, goals of sustainable healthcare and population values. Among seventeen criteria, thirteen were recommended by more than half of panelists. Although the cost-effectiveness ratio was deemed sometimes useful, the validity of universal thresholds to inform allocative efficiency was challenged. Regarding Publicity, panelists recommended communicating the values underlying a decision in reference to broader societal objectives, and being transparent about value judgements in selecting evidence. For Appeals, recommendations included clear definition of new evidence and revision rules. For Implementation, one recommendation was to perform external quality reviews of decisions. While RDRTs raise issues that may warrant special consideration, rarity should be considered in interaction with other aspects (e.g. disease severity, age, budget impact).Conclusions:Improving coverage decision-making towards accountability and reasonableness involves supporting participation and deliberation, enhancing transparency, and more explicit consideration of multiple decision criteria that reflect normative and societal objectives.

The Heterogeneous Nature of Urban Poor Families

2012 ◽  
Vol 11 (1) ◽  
pp. 94-118 ◽  
Author(s):  
Rodrigo Salcedo ◽  
Alejandra Rasse
Keyword(s):  
Decision Making ◽  
Urban Poor ◽  
Poverty Reduction ◽  
The Poor ◽  
Poor Families ◽  
Heterogeneous Nature ◽  
Different Types ◽  
Decision Making Processes ◽  
Different Cultures

This paper addresses the scholarly debate on cultural homogeneity or heterogeneity of urban poor families. While authors such as Lewis (1959) or Wacquant (2000 ; 2001) claim that structural disadvantages are linked to a particular type of identity or culture, others such as Hannerz (1969) , Anderson (1999 ; 2002) , or Portes ( Portes and Manning, 1986 ; Portes and Jensen, 1989 ) believe that it is possible to find different behaviors, expectations, decision–making processes, and outcomes among people living in seemingly identical structural conditions ( Small et al., 2010 ). Using Santiago, Chile, as a case study, we differentiate five different cultures or identities among the poor. Those identities seem to be the product of different historical and political circumstances, as well as of different types of public policies. The paper ends with a discussion of the need for poverty reduction policies to consider these differences among the poor.

‘Stepping on the heads of our Gods'

2015 ◽  
Vol 6 (2) ◽  
pp. 40-56
Author(s):  
Yangji Doma Sherpa ◽  
A. John Sinclair ◽  
Thomas Henley
Keyword(s):  
Decision Making ◽  
Rapid Development ◽  
High Mountain ◽  
Court Cases ◽  
The Public ◽  
Mountain Environments ◽  
Hydroelectric Dam ◽  
Decision Making Processes

The Himalayan region of India is experiencing rapid development in tourism, agriculture, highway construction and hydroelectric dam construction. This research considered the role of the public both within and outside of development decision-making processes in these high mountain environments using the proposed Himalayan Ski Village (HSV) in Manali as a case study. The qualitative data revealed that there has been an extensive array of public participation activity related to the HSV project over approximately 10 years. Very little of this activity has evolved, however, through the formal decision-making process. Rather, most participation activities, such as general house meetings, objection letters, public rallies, court cases against the proposed project, and a religious congregation were instigated by the public to protest the proposed development. The findings also show that involvement in the participatory activities undertaken by the public and project proponent fostered instrumental and communicative learning outcomes.

scholarly journals Club Diplomacy in the Arctic

2019 ◽  
Vol 25 (2) ◽  
pp. 304-326
Author(s):  
Danita Catherine Burke
Keyword(s):  
Decision Making ◽  
International Politics ◽  
The Arctic ◽  
Illustrative Case ◽  
Arctic Council ◽  
Club Membership ◽  
Decision Making Processes ◽  
The Subject ◽  
Illustrative Case Study

Abstract The Arctic Council is frequently called a unique forum but, as this article argues, clubs are common in international politics and in many respects the Arctic Council is a club. This article explores the questions: Why are the Arctic states acting like a club in Arctic politics, and how do internal hierarchies influence how clubs make decisions? As the article illustrates, clubs are the stage for club diplomacy and, in club diplomacy, hierarchies play an important role. Using the Arctic Council as an illustrative case study, this article argues that clubs have internal hierarchies that inform their decision-making processes and their responses to challenges to their status. When clubs try to deal with subjects that extend beyond the boundaries of the sovereignty of club members and the parameters of club membership, club members may suffer from a lack of status and legitimacy to unilaterally deal with the subject.

How Groupware Systems Can Change How an Organisation Makes Decisions

2011 ◽  
pp. 426-433
Author(s):  
Frédéric Adam ◽  
Jean-Charles Pomerol ◽  
Patrick Brézillon
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Decision Support Systems ◽  
Study Protocol ◽  
Support Systems ◽  
Decision Making Processes ◽  
The Impact

In this article, a newspaper company which has implemented a computerised editorial system is studied in an attempt to understand the impact that groupware systems can have on the decision making processes of an organisation. First, the case study protocol is presented, and the findings of the case are described in detail. Conclusions are then presented which pertain both to this case and to the implementation of decision support systems that have a groupware dimension.

Business Intelligence System Design and its Consequences for Knowledge Sharing, Collaboration, and Decision-Making

2020 ◽  
pp. 382-402
Author(s):  
Lapo Mola ◽  
Cecilia Rossignoli ◽  
Andrea Carugati ◽  
Antonio Giangreco
Keyword(s):  
Decision Making ◽  
Knowledge Sharing ◽  
Business Intelligence ◽  
Two Phase ◽  
Intelligence System ◽  
Business Intelligence Systems ◽  
Managerial Implications ◽  
Decision Making Processes

This exploratory study analyses the effects of the technical and organisational characteristics of business intelligence systems (BIS) on knowledge sharing, collaboration, and decision-making processes. The authors conducted a two-phase multi-method investigation. First, we surveyed 30 enterprises using BIS on a regular basis; then, we engaged in an in-depth case study with one of the respondent companies. Our results show that, on average, the technical and organisational characteristics of the BIS are positively associated with an increase in knowledge sharing, leading to an improvement in internal collaboration that subsequently brings improvement in the quality of decision-making. This case study adds that the way the BIS is designed and appropriated in organisations is important in obtaining such results is. A BIS being designed so that it can be appropriated by the general employee base is key in obtaining the desired organizational impacts. This suggests some requirements for BIS design that we will discuss in terms of theoretical and managerial implications.

scholarly journals Decision trees in environmental justice research — a case study on the floods of 2001 and 2010 in Hungary

2019 ◽  
Vol 11 (1) ◽  
pp. 1025-1034 ◽  
Author(s):  
Gyula Nagy ◽  
György Vida ◽  
Lajos Boros ◽  
Danijela Ćirić
Keyword(s):  
Decision Making ◽  
Decision Tree ◽  
Environmental Justice ◽  
Social Groups ◽  
Principal Component ◽  
Decision Making Processes ◽  
Main Factors ◽  
Decision Tree Method ◽  
Tree Method

Abstract Environmental justice is a normative framework for the analysis of environmental impacts on the wellbeing of individuals and social groups. According to the framework, the deprived social groups and ethnic minorities are often more exposed to environmental risks and hazards due to their disadvantaged situation, and due to the lack of representation and political power. To manage the impacts of injustices and to include the citizen in the decision-making processes, proper information is needed on local attitudes and decision-making processes. Therefore, this study sought to (i) identify the main factors shaping the attitudes towards environmental injustices and (ii) to analyse the attitudes and perception of the various social groups and (iii) to identify the main factors which are shaping the attitudes and actions of those who were affected by the floods of 2001 and 2010 through the use of decision tree method. The data for the predictive model was acquired from a questionnaire survey conducted in two disadvantaged and flood-hit Hungarian regions. Based on the survey data, a principal component analysis (PCA) was conducted, which resulted in three principal components; fear, social change, and change in the built environment. The study focused only on the elements of the “fear principal component”, due to the decision tree tool homogenous groups identified in relation to this component. Our analysis showed that ethnicity has a determinative role in the emergence and the level of fear from floods; the Roma respondents expressed a significantly higher level of fear than others.

scholarly journals Beyond the Rhetoric of Participation: A Case Study of Participatory Practices and Power in East Nusa Tenggara, Indonesia

2021 ◽  
Author(s):  
◽  
Cynthia Ecclestone
Keyword(s):  
Decision Making ◽  
Filial Piety ◽  
Skills Training ◽  
Training Programme ◽  
Participatory Development ◽  
Power Dynamics ◽  
Structured Interviews ◽  
Decision Making Processes ◽  
Local Ngo

<p>This study looks critically at the practices of participatory development by a local NGO in East Nusa Tenggara, Indonesia. In doing so, the Life Skills Training programme is chosen as a case study of potentially participatory development. By exploring people’s experiences, perceptions, and feelings about their participation, the study examines the power dynamics in the programme. To gather data, the study used semi-structured interviews and observations. Interviews were conducted with 14 research participants, who were purposively selected from different backgrounds.   The study finds that the approaches of the programme point to lower-level forms of participation, with local people having both minimal involvement and little role in decision-making. Despite the use of the rhetoric of participation, doubts about the quality of participation are raised particularly in relation to gender, age, and religious differences. By scrutinising the ways in which issues of power manifest in the programme, the study demonstrates that issues of power and power relations in participatory development are quite complex. Using the frameworks of power analysis, I argue that issues related to inequalities of power are manifested in the NGO’s domination of decision-making processes, and that these issues were also contributed to by a patriarchal culture and filial piety. More importantly, I argue that people’s participation in the programme is less likely lead to meaningful outcomes if the issues of power imbalances are not addressed.  The study provides useful insights into ways to improve the practices of participatory development. An increased understanding of various forms of power and their implications will be useful for development practitioners to exercise their power to make a difference. Moreover, efforts to reduce power imbalances in participatory development will be inadequate without critically examining and attending to power and its dynamics. Without a deeper understanding of power, development programmes that make claims about participation may be less effective in achieving transformative goals for the intended beneficiaries.</p>

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