Accountability for reasonableness and priority setting in health

Abstract

Priority setting, whether in health or investments in other goods, is required whenever a society must provide for the needs and welfare of its population and resources are limited, which is always. Since health is only one good among many that a society must provide, however important people claim it is, resources for it are always limited. Yet disagreement about resource allocation is pervasive. Arguably, this means that a form of procedural justice must be used to arrive at priority setting commitments. Although health technology assessment (HTA) gives important advice, standard forms of it underdetermine choices about priority setting. If HTA is embedded in a fair, deliberative process, one that meets the conditions involved in accountability for reasonableness, it can enhance the legitimacy and fairness of its recommendations.