Decisions about access to health care and accountability for reasonableness
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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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- 1.Kaiser Family Foundation/Harvard. Kaiser Family Foundation/Harvard national survey of Americans' views on consumer protection in managed care. 1998. Available at: http://www.kff.org/kff/library.htmlGoogle Scholar
- 4.Daniels N.Just Health Care. New York: Cambridge University Press; 1985.Google Scholar
- 5.Daniels N, Light D, Caplan R.Benchmarks of Fairness for Health Care Reform. New York: Oxford University Press; 1996.Google Scholar
- 6.Daniels N.Seeking Fair Treatment: From the AIDS Epidemic to National Health Care Reform. New York: Oxford University Press; 1995: chap. 4.Google Scholar
- 8.Arrow K. Uncertainty and the welfare economics of medical care.Am Econ Rev. 1963; 53:941–973.Google Scholar
- 18.Daniels N. Why saying no to patients in the United States is so hard: cost containment, justice, and provider autonomy.New Engl J Med. 1986;314:1381–1383.Google Scholar