Table 2 The four conditions of accountability for reasonableness (A4R)

Relevance

Rationales for limit-setting decisions must rest on reasons (information and values) that fair-minded parties (managers, clinicians, patients, and affected others) can agree are relevant to meeting health care needs under resources constraints in the priority setting context

Publicity

Limit-setting decisions and their rationales must be publicly accessible

Appeals

There is a mechanism for challenge and dispute resolution regarding limit-setting decisions, including the opportunity for revising decisions in light of further evidence or arguments

Enforcement

There is either voluntary or public regulation of the process to ensure that the first three conditions are met.