Public Dialogues: A Strategy for Health System Reform

AcademyHealthState Health Research & Policy Interest Group Meeting

June 24, 2006

Jill Jamison RissiSt. Luke’s Health Initiatives

Phoenix, AZ

Acknowledgements

ViewPoint Learning Heidi Gantwerk Isabella Furth, Ph.D. Steven Rosell, Ph.D.

SLHI: www.slhi.org

Why?

To understand how people think about the healthcare system.

To see how people’s preferences change as they become more informed.

To understand what mediates the process of preference change.

To develop more effective strategies for achieving reform.

Methodology and Process

Methodology Four dialogues: three public, one with

stakeholders Random selection of public

participants: Phoenix, Tucson & Flagstaff

Day-long, highly structured Qualitative and quantitative measures

Methodology and Process

Process Initial Judgment Creating a vision for the future Moving toward the envisioned

future Final judgment Key insights All videotaped

Why ChoiceWork Dialogues?

Political participation v. deliberation More ballot initiatives+ More polls & surveys= Less deliberation

Internal and external validity Preference for alternatives+ Random selection= Deliberative Public Opinion

Key to the “Black Box” is learning

Starting with Scenarios

Employer-Based Public

Com

pre

hen

sive

Scenario #1Expand Employer-Based coverage

withfull coverage for all.

Scenario #2Create a Public

System “Medicare for All.”

Limite

d

Scenario #3Expand Employer-Based coverage

with limited coverage for all.

Scenario #4Create a public

system that provides the basics – the rest is up to

you.

Rating the Scenarios

Initial vs. Final Preference Scores

6.76.1

4.63.94.0

6.7

4.0

6.1

Scenario 1 Scenario 2 Scenario 3 Scenario 4

InitialFinal

Comprehensive Private

Comprehensive Public

Limited Private

Limited Public

Perspectives on Equity

Final Preference Score by Response to Equity Question

4.0

7.0

3.7

5.7

4.3

5.4 5.3

6.8

Scenario 1 Scenario 2 Scenario 3 Scenario 4Comprehensive

PrivateComprehensive

PublicLimited Private

Limited Public

ŅEveryone is entitled to the same level of health careŅHealth care is like anything else you buy, those who can pay more should be able to get something better

Stakeholders and Next Steps Engage the public directly in efforts to

shape a universal system: Online Dialogue Meeting-in-a-Box

Phase-in a single universal system: Start with kids…

Reform the educational system for healthcare providers: Docs, nurses, other caregivers

Optimism for the Future

“I was shocked when we went around the first time, I continue to be shocked as we finish up the day and very much invigorated. I am heartened by how much common wisdom there is on these issues.” (Stakeholder)

“What I found most surprising is the vastness and complexity of this problem. I’m hoping that I will continue to learn and be able to a spokesperson out there to talk to people when there’s a need…. I think the best thing of all is that I love my state of Arizona and I’ve never seen so much public outreach before … your voice is heard here, and I think that’s a great start.” (Citizen)

“I think I was most surprised by both the citizens’ conclusions and then our own consensus here today in general… I’ve been doing this a while, and I’m really kind of buoyed by today. This gives me a little staying power.” (Stakeholder)

Conclusion

• Multiple options

• Multiple perspectives

• Facts and Values

• Political Leverage

• Stability of Public Judgment

• Democracy