Explorations in consultation of the public and health professionals on priority setting in an inner London health district

Bowling, Ann; Jacobson, Bobbie; Southgate, Lesley

doi:10.1016/0277-9536(93)90138-t

Cited by 118 publications

(79 citation statements)

References 13 publications

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“…Some studies indicate that citizens themselves believe they could have a role in rationing decisions (Bowling et al 1993, McIver 1998, while politicians are seldom mentioned as important actors (Bowling et al 1993, Wiseman et al 2003. Few studies have reported Swedish citizens' views on appropriate decision makers, but they show results similar to those mentioned above (Mossialos & King 1999, Rosén 2006, Werntoft et al 2007.…”

Section: Introductionmentioning

confidence: 90%

It takes a giraffe to see the big picture – Citizens' view on decision makers in health care rationing

Broqvist

Garpenby

2015

Social Science & Medicine

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Previous studies show that citizens usually prefer physicians as decision makers for rationing in health care, while politicians are downgraded. The findings are far from clear-cut due to methodological differences, and as the results are context sensitive they cannot easily be transferred between countries. Drawing on methodological experiences from previous research, this paper aims to identify and describe different ways Swedish citizens understand and experience decision makers for rationing in health care, exclusively on the programme level. We intend to address several challenges that arise when studying citizens' views on rationing by (a) using a method that allows for reflection, (b) using the respondents' nomination of decision makers, and (c) clearly identifying the rationing level. We used phenomenography, a qualitative method for studying variations and changes in perceiving phenomena. Open-ended interviews were conducted with 14 Swedish citizens selected by standard criteria (e.g. age) and by their attitude towards rationing.The main finding was that respondents viewed politicians as more legitimate decision makers in contrast to the results in most other studies. Interestingly, physicians, politicians, and citizens were all associated with some kind of risk related to self-interest in relation to rationing. A collaborative solution for decision making was preferred where the views of different actors were considered important. The fact that politicians were seen as appropriate decision makers could be explained by several factors: the respondents' new insights about necessary trade-offs at the programme level, awareness of the importance of an overview of different health care needs, awareness about self-interest among different categories of decision-makers, including physicians, and the national context of long-term political accountability for health care in Sweden. This study points to the importance of being aware of contextual and methodological issues in relation to research on how citizens experience arrangements for rationing in health care.

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Section: Introductionmentioning

confidence: 90%

It takes a giraffe to see the big picture – Citizens' view on decision makers in health care rationing

Broqvist

Garpenby

2015

Social Science & Medicine

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“…9,10 Researchers advocate patients involvement in health policy decisionmaking as equal partners in order to ensure that population health needs are incorporated in the policy agenda, as well as that the services delivered and policies implemented are addressing these needs effectively. [11][12][13] Increased patient involvement is associated with improved quality and safety of healthcare services, higher cost-effectiveness and better health outcomes. 12,14 In this reasoning, patient involvement is indispensable in the development and implementation of health policies.…”

Section: Introductionmentioning

confidence: 99%

Assessing Patient Participation in Health Policy Decision-Making in Cyprus

Souliotis

Agapidaki

Peppou

et al. 2016

Int J Health Policy Manag

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Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients' involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus.

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“…17,18 However, citizens can bring different knowledge to the decision-making process, 19 as the values and preferences of members of the general public differ from those of healthcare professionals. [20][21][22] The question can be asked: 'Is there is a place for citizen involvement in priority setting for HCMs at the public hospital level?' The aim of this research was to explore healthcare decision-maker's perceptions about public involvement in setting priorities for HCMs in public hospitals in Australia.…”

Section: Introductionmentioning

confidence: 99%

Setting priorities for high-cost medications in public hospitals in Australia: should the public be involved?

Gallego

Taylor²,

Brien

2011

Aust. Health Review

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Aim. To explore healthcare decision makers' perceptions about public involvement in setting priorities for high-cost medications (HCMs) in public hospitals in Australia.Methods. In-depth, semi-structured interviews were conducted with 24 decision-makers (executive directors of hospitals, area health service managers, directors of hospital pharmacy departments and senior medical doctors) in a Sydney Area Health Service. Interviews were digitally recorded, transcribed verbatim, thematically content analysed and coded.Results. The majority of participants perceived that the 'rationing debate' needs to happen in Australia. The community at large should be encouraged to understand that healthcare resources are limited and choices need to be made. The perspectives of the public, according to participants, were considered diverse (tax payers, patients, consumers). Owing to the complexities of the healthcare system, their involvement of the public in decision-making regarding access to HCMs in public hospitals was considered limited. For participants, the role of the public was likely to be at the macro level, deciding how much they were prepared to spend on healthcare.Conclusion. The role of the public in setting priorities for HCMs in public hospitals was perceived by these healthcare decision makers as limited. However since rationing is unavoidable, there should be an explicit debate about the principles and issues concerned.What is known about the topic? Recognition of the importance of engaging the public in healthcare decision making is increasing. However, there is only limited understanding of the role of citizens in current priority setting mechanisms for allocating scarce resources to high-cost technologies such as medications at the public hospital level. What does this paper add? This study describes how involving the public in setting priorities for HCMs can present specific challenges from the perspective of decision makers working in the public hospital system. What are the implications for practitioners? In a time when public awareness is increasing about medical advances the challenge is to find ways of informing and involving the public in the debate about the distribution of healthcare resources. The results from this study will be useful for policy makers working on ways to improve the legitimacy of decisions at the institutional level.

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Explorations in consultation of the public and health professionals on priority setting in an inner London health district

Cited by 118 publications

References 13 publications

It takes a giraffe to see the big picture – Citizens' view on decision makers in health care rationing

It takes a giraffe to see the big picture – Citizens' view on decision makers in health care rationing

Assessing Patient Participation in Health Policy Decision-Making in Cyprus

Setting priorities for high-cost medications in public hospitals in Australia: should the public be involved?

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