the need for global application of the accountability for reasonableness approach to support sustainable outcomes; comment on “expanded hta: enhancing fairness and legitimacy”
نویسندگان
چکیده
the accountability for reasonableness (afr) concept has been developed and discussed for over two decades. its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. this has again influenced the development of the concept, but not led to universal application. the potential use in health technology assessments (htas) has recently been identified by daniels et al as yet another excellent justification for afr-based process guidance that refers to both qualitative and a broader participatory input for hta, but it has raised concerns from those who primarily support the consistency and objectivity of more quantitative and reproducible evidence. with reference to studies of afr-based interventions and the through these repeatedly documented motivation for their consolidation, we argue that it can even be unethical not to take afr conditions beyond their still mainly formative stage and test their application within routine health systems management for their expected support to more sustainable health improvements. the ever increasing evidence and technical expertise are necessary but at times contradictory and do not in isolation lead to optimally accountable, fair and sustainable solutions. technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy in and sustainability. legitimacy, accountability and fairness do not come about without an inclusive and agreed process guidance that can reconcile differences of opinion and indeed differences in evidence to arrive at a by all understood, accepted, but not necessarily agreed compromise in a current context - until major premises for the decision change. afr should be widely adopted in projects and services under close monitoring and frequent reviews.
منابع مشابه
The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”
The accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. This has again influenced the development of the concept, but not led to universal application. The potential use in health technology assessments (HTAs) has recently be...
متن کاملBeyond the Black Box Approach to Ethics!; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”
In the editorial published in this journal, Daniels and colleagues argue that his and Sabin’s accountability for reasonableness (A4R) framework should be used to handle ethical issues in the health technology assessment (HTA)-process, especially concerning fairness. In contrast to this suggestion, it is argued that such an approach risks suffering from the irrrelevance or insufficiency they war...
متن کاملExpanded HTA, Legitimacy and Independence; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”
This brief commentary seeks to develop the analysis of Daniels, Porteny and Urrutia of the implications of expansion of the scope of health technology assessment (HTA) beyond issues of safety, efficacy, and cost-effectiveness. Drawing in particular on experience in the United Kingdom, it suggests that such expansion can be understood not only as a response to the problem of insufficiency of evi...
متن کاملExpanded HTA: Enhancing Fairness and Legitimacy
All societies face the need to make judgments about what interventions (both public health and personal medical) to provide to their populations under reasonable resource constraints. Their decisions should be informed by good evidence and arguments from health technology assessment (HTA). But if HTA restricts itself to evaluations of safety, efficacy, and cost-effectiveness, it risks being vie...
متن کاملThe Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes
The accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. This has again influenced the development of the concept, but not led to universal application. The potential use in health technology assessments (HTAs) has recently be...
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عنوان ژورنال:
international journal of health policy and managementجلد ۶، شماره ۲، صفحات ۱۱۵-۱۱۸
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