Public Reasoning and Health-Care Priority Setting: The Case of NICE
Public Reasoning and Health-Care Priority Setting: The Case of NICE
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DOI：
10.1353/ken.2017.0005
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发表时间：
2017-03-01
影响因子：
1.4
通讯作者：
Littlejohns, Peter
中科院分区：
文献类型：
--
作者：
Rumbold, Benedict;Weale, Albert;Littlejohns, Peter
旨在通过预付计划（无论是通过税收、社会保险还是两者结合）确保患者普遍获得服务的卫生系统需要就其保证的覆盖范围作出决定：这类任务往往落在确定重点的机构身上。本文分析了一个此类机构的决策过程，特别是英国国家健康与护理卓越研究所（NICE），并评估了其道德合理性。特别是，我们考虑NICE的模型在多大程度上可以根据罗尔斯的“合理性”概念被证明是合理的。该测试与著名的合理性问责制（AfR）模型具有某些共同特征，但也提供了另一种选择，即关注NICE等优先设置机构所使用的价值观在多大程度上符合合理性的实质性条件，而不管其程序优点如何。我们发现，虽然NICE的流程在某些方面可以改进，但NICE评估卫生技术和确定卫生保健覆盖重点的总体方法是合理的，这使其成为其他面临类似覆盖困境的卫生保健系统的典范。通过这样做，我们既提供了一个框架来分析NICE过程的道德合理性，也提供了一个可以用来评估其他过程的框架。
Health systems that aim to secure universal patient access through a scheme of prepayments whether through taxes, social insurance, or a combination of the two need to make decisions on the scope of coverage that they guarantee: such tasks often falling to a priority-setting agency. This article analyzes the decision-making processes at one such agency in particular the UK's National Institute for Health and Care Excellence (NICE) and appraises their ethical justifiability. In particular, we consider the extent to which NICE's model can be justified on the basis of Rawls's conception of "reasonableness." This test shares certain features with the well-known Accountability for Reasonableness (AfR) model but also offers an alternative to it, being concerned with how far the values used by priority-setting agencies such as NICE meet substantive conditions of reasonableness irrespective of their procedural virtues. We find that while there are areas in which NICE's processes may be improved, NICE's overall approach to evaluating health technologies and setting priorities for health-care coverage is a reasonable one, making it an exemplar for other health-care systems facing similar coverage dilemmas. In so doing we offer both a framework for analysing the ethical justifiability of NICE's processes and one that might be used to evaluate others.