Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts

Theor Med Bioeth. 2008;29(2):73-85. doi: 10.1007/s11017-008-9062-4. Epub 2008 Jun 6.


It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is "accountability for reasonableness." We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients' rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Conflict of Interest*
  • Conflict, Psychological
  • Decision Making*
  • Ethical Analysis
  • Ethical Theory
  • Health Care Rationing / ethics
  • Health Care Rationing / legislation & jurisprudence*
  • Health Maintenance Organizations / ethics
  • Health Maintenance Organizations / legislation & jurisprudence*
  • Humans
  • Insurance Coverage / ethics
  • Insurance Coverage / legislation & jurisprudence*
  • Medical Laboratory Science / ethics
  • Medical Laboratory Science / legislation & jurisprudence*
  • Norway
  • Patient Rights / ethics
  • Patient Rights / legislation & jurisprudence*
  • Principle-Based Ethics*
  • Social Justice
  • Social Responsibility
  • United Kingdom
  • United States
  • Withholding Treatment / ethics
  • Withholding Treatment / legislation & jurisprudence*