#11466. Necessity under construction - Societal weighing rationality in the appraisal of health care technologies

August 2026publication date
Proposal available till 23-05-2025
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Journal’s subject area:
Law;
Sociology and Political Science;
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More details about the manuscript: Science Citation Index Expanded or/and Social Sciences Citation Index
Abstract:
Health care coverage decisions may employ many different considerations, which are brought together across two phases. The appraisal then contextualises this evidence to arrive at an (advised) coverage decision, but little is known about how this is done. To elucidate how the appraisal committee constructs necessity, we analysed observations and recordings of two appraisal committee meetings, the corresponding documents (five), and interviews with committee members and policy makers (13 interviewees in 12 interviews), with attention to specific necessity argumentations. The appraisal committee constructs necessity in four phases: (1) allowing explicit criteria to steer the process; (2) allowing patient (representative) contributions to challenge the process; (3) bringing new argumentations in from outside and weaving them together; and (4) formulating recommendations to societal stakeholders. The appraisal committee achieves societal weighing rationality, as the committee actively uses argumentations from society and embeds the decision outcome in society.
Keywords:
Deliberative decision-making; Health care decision-making; Necessary health care; Priority setting; Societal weighing

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