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The bare necessities? A realist review of necessity argumentations used in health care coverage decisions

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  • Kleinhout-Vliek, Tineke
  • de Bont, Antoinette
  • Boer, Bert

Abstract

Policy makers and insurance companies decide on coverage of care by both calculating (cost-) effectiveness and assessing the necessity of coverage.

Suggested Citation

  • Kleinhout-Vliek, Tineke & de Bont, Antoinette & Boer, Bert, 2017. "The bare necessities? A realist review of necessity argumentations used in health care coverage decisions," Health Policy, Elsevier, vol. 121(7), pages 731-744.
    • Handle: RePEc:eee:hepoli:v:121:y:2017:i:7:p:731-744
    DOI: 10.1016/j.healthpol.2017.04.011
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    1. Kapiriri, Lydia & Norheim, Ole F. & Martin, Douglas K., 2009. "Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?," Social Science & Medicine, Elsevier, vol. 68(4), pages 766-773, February.
    2. Martin, Douglas K. & Giacomini, Mita & Singer, Peter A., 2002. "Fairness, accountability for reasonableness, and the views of priority setting decision-makers," Health Policy, Elsevier, vol. 61(3), pages 279-290, September.
    3. Gordon, Elisa Jill, 2006. "The political contexts of evidence-based medicine: Policymaking for daily hemodialysis," Social Science & Medicine, Elsevier, vol. 62(11), pages 2707-2719, June.
    4. Henschke, Cornelia, 2012. "Provision and financing of assistive technology devices in Germany: A bureaucratic odyssey? The case of amyotrophic lateral sclerosis and Duchenne muscular dystrophy," Health Policy, Elsevier, vol. 105(2), pages 176-184.
    5. Rosenberg-Yunger, Zahava R.S. & Daar, Abdallah S. & Thorsteinsdóttir, Halla & Martin, Douglas K., 2011. "Priority setting for orphan drugs: An international comparison," Health Policy, Elsevier, vol. 100(1), pages 25-34, April.
    6. Michael Drummond & Adrian Towse, 2014. "Orphan drugs policies: a suitable case for treatment," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 335-340, May.
    7. Bae, Green & Bae, Eun Young & Bae, SeungJin, 2015. "Same drugs, valued differently? Comparing comparators and methods used in reimbursement recommendations in Australia, Canada, and Korea," Health Policy, Elsevier, vol. 119(5), pages 577-587.
    8. Kroneman, Madelon & de Jong, Judith D., 2015. "The basic benefit package: Composition and exceptions to the rules. A case study," Health Policy, Elsevier, vol. 119(3), pages 245-251.
    9. Rooshenas, Leila & Owen-Smith, Amanda & Hollingworth, William & Badrinath, Padmanabhan & Beynon, Claire & Donovan, Jenny L., 2015. "“I won't call it rationing…”: An ethnographic study of healthcare disinvestment in theory and practice," Social Science & Medicine, Elsevier, vol. 128(C), pages 273-281.
    10. Tinghőg, Gustav & Carlsson, Per & Lyttkens, Carl H., 2010. "Individual responsibility for what? – A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system," Health Economics, Policy and Law, Cambridge University Press, vol. 5(2), pages 201-223, April.
    11. Ham, Chris, 1997. "Priority setting in health care: learning from international experience," Health Policy, Elsevier, vol. 42(1), pages 49-66, October.
    12. Stolk, Elly A. & Brouwer, Werner B. F. & Busschbach, Jan J. V., 2002. "Rationalising rationing: economic and other considerations in the debate about funding of Viagra," Health Policy, Elsevier, vol. 59(1), pages 53-63, January.
    13. Koonal Shah & Aki Tsuchiya & Allan Wailoo, 2014. "Valuing health at the end of life: an empirical study of public preferences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 389-399, May.
    14. J. Schreyögg & T. Stargardt & M. Velasco-Garrido & R. Busse, 2005. "Defining the “Health Benefit Basket” in nine European countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 2-10, November.
    15. Mike Paulden & Tania Stafinski & Devidas Menon & Christopher McCabe, 2015. "Value-Based Reimbursement Decisions for Orphan Drugs: A Scoping Review and Decision Framework," PharmacoEconomics, Springer, vol. 33(3), pages 255-269, March.
    16. Fischer, Katharina Elisabeth, 2012. "A systematic review of coverage decision-making on health technologies—Evidence from the real world," Health Policy, Elsevier, vol. 107(2), pages 218-230.
    17. Giacomini, M. & Hurley, J. & Stoddart, G., 2000. "The many meanings of deinsuring a health service: the case of in vitro fertilization in Ontario," Social Science & Medicine, Elsevier, vol. 50(10), pages 1485-1500, May.
    18. Karin Cerri & Martin Knapp & Jose-Luis Fernandez, 2014. "Public funding of pharmaceuticals in the Netherlands: investigating the effect of evidence, process and context on CVZ decision-making," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 681-695, September.
    19. Desser, Arna S., 2013. "Prioritizing treatment of rare diseases: A survey of preferences of Norwegian doctors," Social Science & Medicine, Elsevier, vol. 94(C), pages 56-62.
    20. Mentzakis, Emmanouil & Stefanowska, Patricia & Hurley, Jeremiah, 2011. "A discrete choice experiment investigating preferences for funding drugs used to treat orphan diseases: an exploratory study," Health Economics, Policy and Law, Cambridge University Press, vol. 6(3), pages 405-433, July.
    21. Ulf Persson & Michael Willis & Knut Ödegaard, 2010. "A case study of ex ante, value-based price and reimbursement decision-making: TLV and rimonabant in Sweden," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(2), pages 195-203, April.
    22. Warren G. Linley & Dyfrig A. Hughes, 2013. "Societal Views On Nice, Cancer Drugs Fund And Value‐Based Pricing Criteria For Prioritising Medicines: A Cross‐Sectional Survey Of 4118 Adults In Great Britain," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 948-964, August.
    23. Michael Drummond & Gerard Pouvourville & Elizabeth Jones & Jennifer Haig & Grece Saba & Hélène Cawston, 2014. "A Comparative Analysis of Two Contrasting European Approaches for Rewarding the Value Added by Drugs for Cancer: England Versus France," PharmacoEconomics, Springer, vol. 32(5), pages 509-520, May.
    24. Kisser, Agnes & Tüchler, Heinz & Erdös, Judit & Wild, Claudia, 2016. "Factors influencing coverage decisions on medical devices: A retrospective analysis of 78 medical device appraisals for the Austrian hospital benefit catalogue 2008–2015," Health Policy, Elsevier, vol. 120(8), pages 903-912.
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    2. Reckers-Droog, Vivian & Jansen, Maarten & Bijlmakers, Leon & Baltussen, Rob & Brouwer, Werner & van Exel, Job, 2020. "How does participating in a deliberative citizens panel on healthcare priority setting influence the views of participants?," Health Policy, Elsevier, vol. 124(2), pages 143-151.

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