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Fair Health Care Coverage

Ensuring the fairness of health care coverage decisions, including both the design and administration of health benefits packages, is the second ethical issue addressed by the Ethical Force Program®. Recent evidence suggests that patients and physicians too often perceive that coverage decisions are made in unfair ways or by using inappropriate criteria. This perceived unfairness is compromising trust in the health care system. While difficult coverage decisions must be made, trust in the legitimacy of these decisions is required for the health care system to be most effective and valuable.

The Ethical Force Program® brought together high-level representatives of practitioners, patients, health plans, government, unions, employers, and others in an attempt to develop consensus on specific ways to ensure that decisions about health care coverage are made fairly. Working with stakeholders for over 2 years, the program reached remarkable convergence on steps that can be taken to improve how health care benefits packages are designed and administered. While these steps cannot address all outstanding issues of health care resource allocation, they can provide tangible, and we hope measurable, ways to move the health care system forward.

The Ethical Force Program®
330 N. Wabash
Chicago, Ill. 60611
Phone: (312) 464-5260
EthicalForce@ama-assn.org

Benefits consensus report
Ensuring Fairness in Health Care Coverage Decisions: A consensus report on the ethical design and administration of health care benefits packages

Patient information and brochure
Information and a patient brochure explaining the people and organizations involved in health insurance coverage decisions.

Benefits report FAQs
Frequently asked questions about ensuring fairness in health care coverage decisions.

Expert advisory panel
Members of the Expert Advisory Panel on Fair Coverage Decisions were charged with reviewing existing policies and practices for designing health benefit packages and adjudicating coverage decisions.

Employer's guide (book)
Ensuring Fairness in Health Care Coverage: An Employer's Guide to Making Good Decisions on Tough Issues