BMJ 2000;321:1300-1301 ( 25 November )

Editorials

Accountability for reasonableness

Establishing a fair process for priority setting is easier than agreeing on principles

Papers p 1316

The first 150 words of the full text of this article appear below.

All health systems struggle with the issue of meeting population health needs fairly under resource constraints. Decisions about the implementation of new technologies provide a useful window into the larger issue, and a paper in this week's journal provides a valuable insight into the elements of decision making that decision makers themselves think important in trying to reach fair decisions on applying new technologies in health care.¹

In mixed systems, like that in the United States, decisions whether to fund new technologiesdrugs, devices, proceduresare made both by public agencies, such as the Health Care Financing Administration or the Veterans Administration, and by private indemnity insurers and managed care organisations. In the universal coverage systems of most developed countries such decisions are made by public agencies or authorities. Distrust has grown in all these settings. ^{2 3} Clinicians, patients, and the publicpropelled by the media, the internet, and direct to . . . [Full text of this article]

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