Table 3 Accountability for reasonableness framework requirements
This framework consists of four requirements to come closer to a fair decision-making process about the reimbursement of therapies [23]: |
|---|
1. Publicity: meaning the reimbursement decisions must be publicly accessible and ensures clarity about reasons behind a reimbursement decision |
2. Relevance, also called reasonableness. This condition asks for a reasonable explanation of how the organisation provides “value for money” in meeting the varied health needs of a defined population under reasonable resource constraints. Specifically, an explanation is reasonable if it appeals to reasons and principles that are accepted as relevant |
3. There should be a mechanism to challenge and dispute the resolution regarding limit-setting decisions, this includes the opportunity for revising decisions in light of further evidence or arguments |
4. There should be a voluntary or public regulation of the process to ensure that conditions 1 to 3 are met |