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Implementing accountability for reasonableness – the case of pharmaceutical reimbursement in Sweden

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  • JANSSON, SANDRA

Abstract

This paper aims to describe the priority-setting procedure for new original pharmaceuticals practiced by the Swedish Pharmaceutical Benefits Board (LFN), to analyse the outcome of the procedure in terms of decisions and the relative importance of ethical principles, and to examine the reactions of stakeholders. All the ‘principally important’ decisions made by the LFN during its first 33 months of operation were analysed. The study is theoretically anchored in the theory of fair and legitimate priority-setting procedures by Daniels and Sabin, and is based on public documents, media articles, and semi-structured interviews. Only nine cases resulted in a rejection of a subsidy by the LFN and 15 in a limited or conditional subsidy. Total rejections rather than limitations gave rise to actions by stakeholders. Primarily, the principle of cost-effectiveness was used when limiting/conditioning or totally rejecting a subsidy. This study suggests that implementing a priority-setting process that fulfils the conditions of accountability for reasonableness can result in a priority-setting process which is generally perceived as fair and legitimate by the major stakeholders and may increase social learning in terms of accepting the necessity of priority setting in health care. The principle of cost-effectiveness increased in importance when the demand for openness and transparency increased.

Suggested Citation

  • Jansson, Sandra, 2007. "Implementing accountability for reasonableness – the case of pharmaceutical reimbursement in Sweden," Health Economics, Policy and Law, Cambridge University Press, vol. 2(2), pages 153-171, April.
  • Handle: RePEc:cup:hecopl:v:2:y:2007:i:02:p:153-171_00
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    Cited by:

    1. Angell, Blake & Pares, Jennie & Mooney, Gavin, 2016. "Implementing priority setting frameworks: Insights from leading researchers," Health Policy, Elsevier, vol. 120(12), pages 1389-1394.
    2. Dale, Elina & Peacocke, Elizabeth F. & Movik, Espen & Voorhoeve, Alex & Ottersen, Trygve & Kurowski, Christoph & Evans, David B. & Norheim, Ole Frithjof & Gopinathan, Unni, 2023. "Criteria for the procedural fairness of health financing decisions: a scoping review," LSE Research Online Documents on Economics 119799, London School of Economics and Political Science, LSE Library.
    3. Kapiriri, Lydia & Razavi, Donya, 2017. "How have systematic priority setting approaches influenced policy making? A synthesis of the current literature," Health Policy, Elsevier, vol. 121(9), pages 937-946.
    4. Franken, Margreet & Stolk, Elly & Scharringhausen, Tessa & de Boer, Anthonius & Koopmanschap, Marc, 2015. "A comparative study of the role of disease severity in drug reimbursement decision making in four European countries," Health Policy, Elsevier, vol. 119(2), pages 195-202.
    5. 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.
    6. Tania Stafinski & Devidas Menon & Deborah Marshall & Timothy Caulfield, 2011. "Societal Values in the Allocation of Healthcare Resources," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 4(4), pages 207-225, December.
    7. Katharina Fischer & Reiner Leidl, 2014. "Analysing coverage decision-making: opening Pandora’s box?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 899-906, December.
    8. Petricca, Kadia & Bekele, Asfaw & Berta, Whitney & Gibson, Jennifer & Pain, Clare, 2018. "Advancing methods for health priority setting practice through the contribution of systems theory: Lessons from a case study in Ethiopia," Social Science & Medicine, Elsevier, vol. 198(C), pages 165-174.

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