The 130th Annual Meeting of APHA

Abstract #50969

Amber S. Orr, JD, Fellow, AMA Institute for Ethics, 515 North State Street, Chicago, IL 60610, 312 464-4830, amber_orr@ama-assn.org and Matthew K. Wynia, MD, MPH, Institute for Ethics, American Medical Association, 515 North State Street, Chicago, IL 60610.

Recent evidence suggests that patients and physicians too often perceive the current health care system to be unfair or illegitimate because of the ways in which coverage decisions appear to be made. This perceived unfairness is disrupting trust in the health care system. Developing a framework that would promote trust in health care organizations by fostering and demonstrating fairness in coverage decisions would provide value to all participants in the health care system.

For two years, the Ethical Force Program has been working to develop such a framework. The proposed framework was created using a rigorous process for consensus building, including substantial input from a national expert advisory panel and multiple rounds of review by the Ethical Force Program Oversight Body, which includes the perspectives of patients, practitioners, purchasers, providers and others.

Concrete recommendations are then listed as steps that can be taken by specific types of organizations to demonstrate that attention is being given to each of the 5 content areas. These recommended steps are called measurable expectations, to reflect the fact that performance in meeting these expectations could be measured.

The steps listed in the report, should provide fresh impetus to organizations throughout the health care system to develop a level playing field, promote trust and understanding of how coverage decisions are made, and thereby improve the health and well-being of the American people.

Learning Objectives:

• Recognize themes in the ethics of resource allocation.
• Develop an understanding of the consensus decisions on benefits determinations.
• Evaluate how to translate ethical aspirations into useful performance measures to improve health care.

Keywords: Accountability, Insurance

Related Web page: www.ama-assn.org/e-force

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: The Ethical Force Program
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am employed as a fellow by the AMA who funds the Ethical Force Program.