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Accounting for reasonableness: Exploring the personal internal framework affecting decisions about cancer drug funding


  • Sinclair, Shane
  • Hagen, Neil A.
  • Chambers, Carole
  • Manns, Braden
  • Simon, Anita
  • Browman, George P.


Objectives Drug decision-makers are involved in developing and implementing policy, procedure and processes to support health resource allocation regarding drug treatment formularies. A variety of approaches to decision-making, including formal decision-making frameworks, have been developed to support transparent and fair priority setting. Recently, a decision tool, 'The 6-STEPPPs Tool', was developed to assist in making decisions about new cancer drugs within the public health care system.Methods We conducted a qualitative study, utilizing focus groups and participant observation, in order to investigate the internal frameworks that supported and challenged individual participants as they applied this decision tool within a multi-stakeholder decision process.Results We discovered that health care resource allocation engaged not only the minds of decision-makers but profoundly called on the often conflicting values of the heart.Conclusions Objective decision-making frameworks for new drug therapies need to consider the subjective internal frameworks of decision-makers that affect decisions. Understanding the very human, internal turmoil experienced by individuals involved in health care resource allocation, sheds additional insight into how to account for reasonableness and how to better support difficult decisions through transparent, values-based resource allocation policy, procedures and processes.

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  • Sinclair, Shane & Hagen, Neil A. & Chambers, Carole & Manns, Braden & Simon, Anita & Browman, George P., 2008. "Accounting for reasonableness: Exploring the personal internal framework affecting decisions about cancer drug funding," Health Policy, Elsevier, vol. 86(2-3), pages 381-390, May.
  • Handle: RePEc:eee:hepoli:v:86:y:2008:i:2-3:p:381-390

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    References listed on IDEAS

    1. 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.
    2. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Who cares about cost? Does economic analysis impose or reflect social values?," Health Policy, Elsevier, vol. 34(2), pages 79-94, November.
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    Cited by:

    1. Hipgrave, David B. & Alderman, Katarzyna Bolsewicz & Anderson, Ian & Soto, Eliana Jimenez, 2014. "Health sector priority setting at meso-level in lower and middle income countries: Lessons learned, available options and suggested steps," Social Science & Medicine, Elsevier, vol. 102(C), pages 190-200.

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