Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts.
It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is "accountability for reasonableness." We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients' rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks.
Sabik
Lindsay M
LM
Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA.
Lie
Reidar K
RK
D016265:Conflict of Interest; D003220:Conflict, Psychological; D003657:Decision Making; D026689:Ethical Analysis; D028663:Ethical Theory; D015276:Health Care Rationing / Q000941:ethics / Q000331:legislation & jurisprudence*; D006279:Health Maintenance Organizations / Q000941:ethics / Q000331:legislation & jurisprudence*; D006801:Humans; D019458:Insurance Coverage / Q000941:ethics / Q000331:legislation & jurisprudence*; D013677:Medical Laboratory Science / Q000941:ethics / Q000331:legislation & jurisprudence*; D009664:Norway; D028701:Patient Rights / Q000941:ethics / Q000331:legislation & jurisprudence*; D028662:Principle-Based Ethics; D012935:Social Justice; D012941:Social Responsibility; D006113:United Kingdom; D014481:United States; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence*