‘The public is too subjective’: public involvement at different levels of health-care decision making

Litva, Andrea; Coast, Joanna; Donovan, Jenny; Eyles, John; Shepherd, Michael; Tacchi, Jo; Abelson, Julia; Morgan, Kieran

doi:10.1016/s0277-9536(01)00151-4

Cited by 184 publications

(204 citation statements)

References 15 publications

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“…The dominant picture in previous research on this topic seems to be that citizens prefer physicians as decision makers for rationing in health care (Richardson et al 1992, Myllykangas et al 1996, Bowling 1996, Kneeshaw 1997, Busse 1999, Litva et al 2002, Wiseman et al 2003. 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.…”

Section: Introductionmentioning

confidence: 99%

“…First, that rationing is carried out on multiple levels, which complicates the issue. Litva et al (2002), distinguishing between three different levels, explained that citizens' views might vary according to the level being addressed. what rationing is all about (Wiseman et al 2003).…”

Section: Introductionmentioning

confidence: 99%

“…what rationing is all about (Wiseman et al 2003). Litva et al (2002) focus on public involvement in rationing and highlight the importance of specifying the decision level. Mitton et al (2009) point to the programme level as under-researched with regard to studies of citizens and priority setting.…”

Section: Introductionmentioning

confidence: 99%

“…Thirdly, scholars have drawn attention to the differences in questions about citizens' willingness to participate in rationing processes (Bowling 1996, Mossialos & King 1999, Litva et al 2002, Lee et al 2002, Wiseman et al 2003. In the 1960s Arnstein pointed to the importance of clarifying the degree of participation, ranging from manipulation to real control (Arnstein 1969).…”

Section: Introductionmentioning

confidence: 99%

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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: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Public involvement in decision making in matters related to health has been an area of focus in science and technology studies (Evans & Plows, 2007;Felt & Fochler, 2010;Marres, 2011) and health policy research (Abelson et al, 2003;Evans & Plows, 2007;Felt & Fochler, 2010;Litva et al, 2002;Marres, 2011;Tenbensel, 2010). While much of this literature focuses on public consultation per se, rather than specifically on deliberation, three basic constructions of the public are commonly employed (Braun & Schultz, 2010;Charles & DeMaio, 1993;Litva et al, 2009;Martin, 2012).…”

Section: Conceptual Analysismentioning

confidence: 99%

Which public and why deliberate? – A scoping review of public deliberation in public health and health policy research

Degeling

Carter

Rychetnik

2015

Social Science & Medicine

168

176

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Deliberative methods are of increasing interest to public health researchers and policymakers. We systematically searched the peer-reviewed literature to identify public health and health policy research involving deliberative methods and report how deliberative methods have been used. We applied a taxonomy developed with reference to health policy and science and technology studies literatures to distinguish how deliberative methods engage different publics: citizens (ordinary people who are unfamiliar with the issues), consumers (those with relevant personal experience e.g. of illness) and advocates (those with technical expertise or partisan interests). We searched four databases for empirical studies in English published 1996-2013. This identified 78 articles reporting on 62 distinct events from the UK, USA, Canada, Australasia, Europe, Israel, Asia and Africa. Ten different types of deliberative techniques were used to represent and capture the interests and preferences of different types of public. Citizens were typically directed to consider community interests and were treated as a resource to increase democratic legitimacy. Citizens were preferred in methodological studies (those focused on understanding the techniques). Consumers were directed to focus on personal preferences; thus convened not as a source of policy decisions, but of knowledge about what those affected by the issue would accept. Advocates-who are most commonly used as expert witnesses in jurieswere sometimes engaged to deliberate with consumers or citizens. This almost always occurred in projects directly linked to policy processes. This suggests health policymakers may value deliberative methods as a way of understanding disagreement between perspectives. Overall however, the 'type' of public sought was often not explicit, and their role not specified. This review provides new insight into the heterogeneity and rising popularity of deliberative methods, and indicates a need for greater clarity regarding both the constitution of publics and the relative usefulness of different deliberative techniques.

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Consumers’ and health providers’ views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis

Merner

Schonfeld

Virgona

et al. 2023

Cochrane Database of Systematic Reviews

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‘The public is too subjective’: public involvement at different levels of health-care decision making

Cited by 184 publications

References 15 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

Which public and why deliberate? – A scoping review of public deliberation in public health and health policy research

Consumers’ and health providers’ views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis

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