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Conditions of Accountability for Reasonableness framework |
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| Condition |
Description |
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| Publicity |
Limit-setting decisions and their rationales must be publicly accessible. |
| Relevance |
These rationales must rest on evidence, reasons, and principles that fair-minded parties (managers, clinicians, patients, and consumers in general) can agree are relevant to deciding how to meet the diverse needs of a covered population under necessary resource constraints. |
| Appeals |
There is a mechanism for challenge and dispute resolution regarding limit-setting decisions, including the opportunity for revising decisions in light of further evidence or arguments. |
| Enforcement |
There is either voluntary or public regulation of the process to ensure that the first three conditions are met. |
Mitton and Donaldson Cost Effectiveness and Resource Allocation 2004 2:3 doi:10.1186/1478-7547-2-3 |
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