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Published on: February 16, 2011
Getting fairer over time? Assessing changes in health technology funding processes using the accountability for
Jing Jing Li1, Marcus Sellars2, Joanna Coast3
1Centre for Health Economics, Monash Business School, Monash University, Level 5, Building H, Caulfield Campus, Melbourne, VIC, 3145, Australia. jingjing.li@monash.edu.
Summary
Australian health technology funding committees (PBAC and MSAC) are increasingly aligning with fairness principles over time. Improvements in relevance, publicity, and enforcement were noted, though challenges in transparency persist.
Area of Science:
- Health Policy
- Health Economics
- Medical Technology Assessment
Background:
- Fair distribution of limited health funding is a global challenge.
- Health technology funding decisions offer insight into priority-setting processes.
- The Accountability for Reasonableness (A4R) framework provides criteria for fair priority-setting.
Purpose of the Study:
- To examine how two mature centralized health technology funding review processes, Australia's PBAC and MSAC, have addressed fairness over time.
- To assess the application of the A4R framework in these committees' decision-making.
Main Methods:
- Document review of policy changes from 2014-2022.
- Semi-structured interviews with PBAC and MSAC decision-makers in 2014 (n=12) and 2021/22 (n=11).
Main Results:
- Increased alignment with A4R principles observed over time.
- Enhanced Relevance (consumer representation), Publicity (decision rationales), and Enforcement (committee deliberation) were noted.
- Revision was less emphasized by members, despite policy improvements; persistent barriers to Publicity (confidentiality, complex deliberations) were identified.
Conclusions:
- Australian health technology assessment bodies show improved procedural fairness aligned with A4R principles.
- Challenges remain in balancing transparency (Publicity) with commercial confidentiality and communicating complex decision-making.
- Findings highlight practical application of A4R and the tension between procedural fairness and substantive ethical considerations.
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