Scholarlink

<p>Fair distribution of limited health funding is a universal challenge for health systems. Decisions about funding new technologies provide a helpful lens on this complex issue. This study examined how two of the world’s most mature centralised review processes for health technology funding, namely the Australian Pharmaceutical Benefits and Medical Services Advisory Committees (PBAC and MSAC) have approached fairness over time. Using the Accountability for Reasonableness (A4R) framework, which defines fair priority-setting through four conditions (<i>Relevance</i>,<i> Publicity</i>,<i> Revision</i>, and <i>Enforcement)</i>, we conducted (i) a detailed document review of policy changes (2014–2022) and (ii) semi-structured interviews with decision-makers at PBAC and MSAC in 2014 (<i>n</i> = 12) and 2021/22 (<i>n</i> = 11). In both the document review and the interviews, we found increased alignment with A4R principles over time, including enhanced <i>Relevance</i> through increased consumer representation, increased <i>Publicity</i> of decision rationales, and greater <i>Enforcement</i> through broader committee deliberation. However, <i>Revision</i> was not a pressing concern of committee members at either time point despite notable policy changes that improved <i>Revision</i>. Persistent barriers to <i>Publicity</i> were identified, particularly the redaction of decision rationales in public summary documents due to sponsor confidentiality requirements and challenges of explaining nuanced deliberations rather than formulaic criteria. Our findings illustrate how A4R principles are applied in practice and highlight the challenge of balancing procedural fairness with substantive ethical considerations, such as equity and cost effectiveness, that underlie the criterion of <i>Relevance</i>.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Getting fairer over time? Assessing changes in health technology funding processes using the accountability for reasonableness (A4R) framework

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月23日

查看全文
  • Jing Jing Li,
  • Marcus Sellars,
  • Joanna Coast,
  • Stacy M. Carter,
  • Kirsten Howard,
  • Duncan Mortimer,
  • Emily Lancsar

摘要

Fair distribution of limited health funding is a universal challenge for health systems. Decisions about funding new technologies provide a helpful lens on this complex issue. This study examined how two of the world’s most mature centralised review processes for health technology funding, namely the Australian Pharmaceutical Benefits and Medical Services Advisory Committees (PBAC and MSAC) have approached fairness over time. Using the Accountability for Reasonableness (A4R) framework, which defines fair priority-setting through four conditions (Relevance, Publicity, Revision, and Enforcement), we conducted (i) a detailed document review of policy changes (2014–2022) and (ii) semi-structured interviews with decision-makers at PBAC and MSAC in 2014 (n = 12) and 2021/22 (n = 11). In both the document review and the interviews, we found increased alignment with A4R principles over time, including enhanced Relevance through increased consumer representation, increased Publicity of decision rationales, and greater Enforcement through broader committee deliberation. However, Revision was not a pressing concern of committee members at either time point despite notable policy changes that improved Revision. Persistent barriers to Publicity were identified, particularly the redaction of decision rationales in public summary documents due to sponsor confidentiality requirements and challenges of explaining nuanced deliberations rather than formulaic criteria. Our findings illustrate how A4R principles are applied in practice and highlight the challenge of balancing procedural fairness with substantive ethical considerations, such as equity and cost effectiveness, that underlie the criterion of Relevance.