Ensuring a fair deal for all in the health care system

A new report describes how fairness can be improved in health care coverage decisions.

Editorial. April 19, 2004.

In a health care system viewed, with good reason, as increasingly polarized and contentious, the notion of "fairness" is taking quite a beating. Yet fairness -- along with other endangered species such as privacy and respect -- is key if the system will truly serve this society.

A new report entitled "Ensuring Fairness in Health Care Coverage Decisions" is an important step in restoring faith in this essential system. It is the work of a wide-ranging panel brought together by the AMA Institute for Ethics.

The report outlines a consensus on five criteria for fairness that insurers and others should follow: Health care coverage decisions should be participatory, equitable, consistent, compassionate, transparent and sensitive to value. These should be givens, but talk to just about any patient or physician and the war stories they tell underscore the need for commitment and progress in these areas.

The report was developed by the institute's Ethical Force Program. This broad-based effort was founded by the institute in 1997 to develop performance measures for health care ethics that can be applied to all participants in health care, including hospitals, physicians, health plans, employer/purchasers and investors.

The current health care environment has fostered a competitiveness among these stakeholders that leaves each of them feeling that the other ones are somehow getting a "better deal." This is particularly true for physicians and patients, many of whom feel powerless.