Modelli deliberativi per l’allocazione delle risorse in sanità: il caso della dengue in Tanzania

2019 ◽  
Vol 68 (3) ◽  
pp. 313-335
Author(s):  
Elena Mancini ◽  
Roberta Martina Zagarella
Keyword(s):  
Accountability For Reasonableness ◽  
Norman Daniels

Nei piani di intervento a sostegno dei sistemi sanitari dei paesi in via di sviluppo, l’utilizzo prevalente di approcci tecnici (basati su strumenti economici) ha rappresentato la via maestra per l’individuazione delle priorità sanitarie. Tali approcci mostrano tuttavia il limite, sotto il profilo etico, di non includere un’analisi dei valori e del contesto culturale e di essere scarsamente responsivi nei confronti delle reali domande di salute della popolazione. Nascondono, inoltre, un sostanziale conflitto tra i valori sottesi, quali l’efficienza e l’equità. La nostra analisi si rivolge ai modelli partecipati e deliberativi di allocazione delle risorse, e specialmente all’approccio elaborato da Norman Daniels – che prende il nome di Accountability for Reasonableness (A4R) – con l’intento di proporre un metodo finalizzato alla definizione di priorità “giuste”, definite cioè non in base a predefinite scelte di valori bensì derivanti da una procedura deliberativa legittima (trasparente e negoziata tra tutti i portatori di interessi in gioco). Per testare l’applicabilità in circostanze reali (soprattutto per paesi a basso reddito) del modello A4R, l’articolo propone l’analisi dello studio di un caso. In particolare, viene esaminata una concreta applicazione dell’A4R relativa alla prioritarizzazione degli interventi di contrasto alla Dengue in Tanzania, al fine di mostrare cosa ha funzionato in questa circostanza specifica, quali difficoltà si sono incontrate e quali reazioni sono scaturite da parte della popolazione.

Moral ambivalence towards the Cancer Drugs Fund

2019 ◽  
Vol 45 (9) ◽  
pp. 623-626 ◽  
Author(s):  
Ilias Ektor Epanomeritakis
Keyword(s):  
Cancer Patient ◽  
Procedural Justice ◽  
Resource Distribution ◽  
Public Welfare ◽  
Cancer Drugs ◽  
Ethical Concerns ◽  
Accountability For Reasonableness ◽  
Present Essay ◽  
Moral Ambivalence ◽  
Robust Framework

The UK’s Cancer Drugs Fund (CDF) was introduced in 2010 following the Conservative Party’s promise to address the fact that numerous efficacious cancer drugs were not available because of their cost ineffectiveness, as deduced by the National Institute of Health and Care Excellence. While, at face value, this policy appears only to promote the UK’s public welfare, a deeper analysis reveals the ethically unjustifiable inconsistencies that the CDF introduces; where is the analogous fund for other equally severe diseases? Have the patients without cancer been neglected simply due to the fear-inducing advertising and particularly ferocious speech which surrounds cancer? The CDF is unjustifiable when challenged by such questions. However, it is troubling to think that the CDF might be repealed in order to abolish these ethical concerns. Intuitively, one feels uncomfortable stripping the cancer patient of their benefits just so that they might be on an equally pessimistic footing with others. In the present essay, I argue that, although there are no ethically justifiable grounds for the CDF’s introduction, its removal would be inappropriate. Following this realisation, I investigate whether the procedural steps of the CDF itself—theoretically removed from the context of resource distribution for all disease types—represent an ethically justifiable system. I believe that the answer is yes, given the CDF’s conformity to accountability for reasonableness, a robust framework of procedural justice, which continuously improves the ethical and epistemological standards of the policies to which it is applied.

scholarly journals Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation

2011 ◽  
Vol 6 (1) ◽  
Author(s):  
Stephen Maluka ◽  
Peter Kamuzora ◽  
Miguel SanSebastián ◽  
Jens Byskov ◽  
Benedict Ndawi ◽  
...  
Keyword(s):  
Realist Evaluation ◽  
District Level ◽  
Accountability For Reasonableness

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.

Norman Daniels. Just Health

2008 ◽  
Vol 1 (3) ◽  
pp. 268-272
Author(s):  
T. Wilkinson
Keyword(s):  
Norman Daniels

Reasonableness and its definition in the provision of health care

2010 ◽  
pp. 54-58
Author(s):  
Norman Daniels
Keyword(s):  
Health Care ◽  
Developing Countries ◽  
Health Policy ◽  
Developed Countries ◽  
Fair Process ◽  
Accountability For Reasonableness ◽  
The United Kingdom ◽  
Ethical Controversy ◽  
Rationing Problems ◽  
New Evidence

Two central goals of health policy are to improve population health as much as possible and to distribute the improvements fairly. These goals will often conflict. Reasonable people will disagree about how to resolve these conflicts, which take the form of various unsolved rationing problems. The conflict is also illustrated by the ethical controversy that surrounds the use of cost-effectiveness analysis. Because there is no consensus on principles to resolve these disputes, a fair process is needed to assure outcomes that are perceived to be fair and reasonable. One such process, accountability for reasonableness, assures transparency, involves stakeholders in deliberating about relevant rationales, and requires that decisions be revised in light of new evidence and arguments. It has been influential in various contexts including developed countries such as Canada, the United Kingdom, New Zealand, and Sweden, and developing countries, such as Mexico....

OP83 Value Assessment Framework: Evidence-Informed Deliberative Processes

2017 ◽  
Vol 33 (S1) ◽  
pp. 38-38
Author(s):  
Marcia Tummers ◽  
Rob Baltussen ◽  
Maarten Jansen ◽  
Leon Bijlmakers ◽  
Janneke Grutters ◽  
...  
Keyword(s):  
Decision Making ◽  
Priority Setting ◽  
Stakeholder Involvement ◽  
Value Assessment ◽  
Assessment Framework ◽  
Accountability For Reasonableness ◽  
A Value ◽  
Public Scrutiny ◽  
The One ◽  
Deliberative Processes

INTRODUCTION:Priority setting in health care has been long recognized as an intrinsically complex and value-laden process. Yet, Health Technology Assessment (HTA) agencies presently employ value assessment frameworks that are ill-fitted to capture the range and diversity of stakeholder values, and thereby risk to compromise the legitimacy of their recommendations. We propose ‘evidence-informed deliberative processes’ as an alternative framework with the aim to enhance this legitimacy.METHODS:The framework is based on an integration of two increasingly popular and complementary frameworks for priority setting: multi-criteria decision analysis (MCDA) and accountability for reasonableness (A4R), Evidence-informed deliberative processes are, on the one hand, based on early, continued stakeholder deliberation to learn about the importance of relevant social values. On the other hand, they are based on rational decision-making – through evidence-informed evaluation of the identified values.RESULTS:The framework has important implications for how HTA agencies should ideally organize their processes. Firstly, HTA agencies should take the responsibility to organize stakeholder involvement. Second, agencies are advised to integrate their assessment and appraisal phase, allowing for the timely collection of evidence on values that are considered relevant. Third, HTA agencies should subject their specification of decision-making criteria to public scrutiny. Fourth, agencies are advised to use a checklist of potentially relevant criteria, and to provide argumentation how each criterion affected the recommendation. Fifth, HTA agencies must publish their argumentation and install options for appeal.CONCLUSIONS:Adopting ‘evidence-informed deliberative processes’ as a value assessment framework could be an important step forward for HTA agencies to optimize the legitimacy of their priority setting decisions. Agencies can incorporate elements according to their needs and affordances.

scholarly journals Accountability for reasonableness

BMJ ◽  
2000 ◽  
Vol 321 (7272) ◽  
pp. 1300-1301 ◽  
Author(s):  
N. Daniels
Keyword(s):  
Accountability For Reasonableness
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