What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions?

160 Ontario hospital Chief Executive Officers, or their designates, were asked to complete a survey questionnaire concerning priority setting in their publicly funded institutions. Eight-six Ontario hospitals completed this survey, for a response rate of 54%. Six close-ended rating scale questions (e.g. Overall, how fair is priority setting at your hospital?), and 3 open-ended questions (e.g. What do you see as the goal(s) of priority setting in your hospital?) were used.Overall, 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to the 'accountability for reasonableness' conditions, respondents indicated their hospitals performed best for the relevance (75.0%) condition, followed by appeals/revision (56.6%), publicity (56.0%), and enforcement (39.5%).For the first time hospital Chief Executive Officers within an entire health system were surveyed about the fairness of priority setting practices in their institutions using the conceptual framework 'accountability for reasonableness'. Although many hospital CEOs felt that their priority setting was fair, ample room for improvement was noted, especially for the enforcement condition.Priority setting, also known as rationing or resource allocation, occurs at all levels of every health care system, including governments, funded provincial/territorial agencies, pharmaceutical benefit-management organizations, hospitals and clinical programs [1]. Countries with very different health care systems and levels of health care are all grappling with the problem of how to reconcile growing demands and constrained resources [2]. Hospitals, in particular, are struggling to meet growing demands, affordably, without compromising delivery of services [3,4].Daniels and Sabin have proposed a framework for priority setting in health care institutions called 'accountability for reasonableness' [5-7], which links priority setting to theories of democratic deliberation, operationalizing the ethical conc