Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?
Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?
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DOI：
10.1016/j.socscimed.2008.11.011
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发表时间：
2009-02-01
影响因子：
5.4
通讯作者：
Martin, Douglas K.
中科院分区：
文献类型：
--
作者：
Kapiriri, Lydia;Norheim, Ole F.;Martin, Douglas K.
合理性问责是公平优先级设定过程的道德框架。该框架已用于评估多种情况下的公平性，并且一些研究评估了决策者的可接受性。然而，没有研究比较该框架的四个条件对卫生系统和优先事项设定级别的决策者的可接受性。本文报告了加拿大（安大略省）、挪威和乌干达医疗保健系统中参与优先级设置的宏观、中观和微观层面的 184 名决策者描述的公平要素，并将其与“合理性问责”的四个条件以及跨决策和医疗保健系统的各个层面进行比较。我们的受访者确定了公平优先级设置的 23 个要素。其中大多数 (17) 都非常符合合理性问责的四个条件；六个没有。跨卫生保健系统和决策水平的比较表明，四个要素（透明度、参与性、基于需求的标准和客观性）是所有人共有的，其余要素仅是卫生保健系统（但不是所有级别）或仅决策级别（但不是所有卫生系统）共同的。不同决策级别的看法存在显着差异。本研究中发现的公平要素与合理性问责条件之间的重叠表明，这四个条件在整个医疗保健系统和决策级别中都是可识别和适用的。然而，该框架应灵活使用，以允许识别要素和相关的明确标准（例如本研究中确定的标准）——可能不直接适合这四种条件中的任何一种。 (C) 2008 Elsevier Ltd. 保留所有权利。
Accountability for reasonableness is an ethical framework for fair priority setting process. This framework has been used to evaluate fairness in several contexts, and a few studies have evaluated its acceptability to decision makers. However, no studies have compared the acceptability of the four conditions of the framework to decision makers across health systems and levels of priority setting. This paper reports the elements of fairness described by 184 decision makers involved in priority setting at the macro-, meso- and micro-levels of priority setting in the Canadian (Ontario), Norwegian and Ugandan health care systems and compares them against the four conditions of 'Accountability for Reasonableness' and across levels of decision making, and health care systems.Our respondents identified 23 elements of fair priority setting. Most of these (17) were well aligned with the four conditions of Accountability for Reasonableness; six were not. Comparisons across health care system and levels of decision making revealed that four elements (transparency, participatory and among the criteria-need based and objective) were common to all and the rest were common to only the health care systems (but not at all levels), or only the levels of decision making (but not to all health are systems). Perceptions varied remarkably across levels of decision making.The overlap between the elements of fairness found in this study and the conditions of Accountability for Reasonableness demonstrates that the four conditions are recognizable and applicable across health care systems and levels of decision making. However, the framework should be used with flexibility to allow for identification of elements and relevant explicit criteria (such as those identified in this study)-that may not directly fit under any of the four conditions. (C) 2008 Elsevier Ltd. All rights reserved.