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

From: Rationing for medicines by health care providers in Indonesia National Health Insurance System at hospital setting: a qualitative study

Conditions Description
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.
  1. Source: adapted from Daniels and Sabin [11]