The Risk-Benefit Balance in the United States

Who Decides?

Published in: Health Affairs, v. 26, no. 3, May-June. 2007, p. 625-635

Posted on RAND.org on December 31, 2006

by John D. Graham, Jianhui Hu

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A health policy decision often requires a balancing of risks, costs, and benefits. In this paper the authors illustrate that there is no uniform answer in the United States to the question of who decides the risk-benefit balance. The authors use a wide range of case examples from medicine and public health to show the different approaches that are used to allocate decision-making responsibility. Our ultimate purpose is to urge the U.S. health policy community to develop a more consistent way of thinking about how risk-benefit decisions could be guided by general principles.

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