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J Urban Health. 1999 Jun;76(2):176-91.

Decisions about access to health care and accountability for reasonableness.

Author information

1
Department of Philosophy, Tufts University, Medford, MA 02155, USA. ndaniels@emerald.tufts.edu

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.

PMID:
10924028
PMCID:
PMC3455985
DOI:
10.1007/BF02344674
[Indexed for MEDLINE]
Free PMC Article

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