Journal of Urban Health

, Volume 76, Issue 2, pp 176–191 | Cite as

Decisions about access to health care and accountability for reasonableness

  • Norman Daniels
Martin Cherkasky Symposium

Abstract

Insurers make decisions that directly limit access to care (e.g., when deciding about coverage for new technologies or formulary design) and that indirectly limit access (e.g., by adopting incentives to induce physicians to provide fewer or different services). These decisions raise questions about legitimacy and fairness. By holding health plans accountable for the reasonableness of their decisions, it is possible to address these questions. Accountability for reasonableness involves providing publicly accessible rationales for decisions and limiting rationales to those that all “fair-minded” persons can agree are relevant to meeting patient needs fairly under resource constraints. This form of accountability is illustrated by examining its implications for the three examples of direct and indirect limit setting noted here.

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Copyright information

© The New York Academy of Medicine 1999

Authors and Affiliations

  • Norman Daniels
    • 1
  1. 1.Department of PhilosophyTufts UniversityMedford

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