Benefits consensus report

Ensuring fairness in health care coverage decisions: A consensus report on the ethical design and administration of health care benefits packages

Ethical Force Consensus Report (PDF, 223KB, requires Adobe® Reader®)

Consensus Report Executive Summary (PDF, 26KB)

This report is the first product of the Ethical Force Program's initiative on fair coverage decisions. The aim of the report is to set out a framework that health care organizations can use as a guide for ensuring and assessing fairness in the design and administration of their health care benefits packages. The framework contained in the report consists of 5 content areas that organizations should attend to when making health care coverage decisions. The report recommends that organizational processes for designing and administering health benefits should be transparent, participatory, equitable and consistent, sensitive to value, and compassionate. Within the report each of these 5 content areas is fully explained.

For each of the five content areas, the report also sets out a series of measurable expectations—more than 70 in all. These expectations are concrete recommendations for measurable actions that can be taken by specific organizations to demonstrate that attention is being given to each of the five content areas with regard to both the design and administration of health benefits packages.