Oregon Health Decisions

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Oregon Health Decisions

• Community Meetings Process
• Michael J. Garland, D. Sc. Rel.
• Professor Emeritus
• Public Health and Preventive Medicine
• Senior Scholar
• Center for Ethics in Health Care
• Oregon Health Science University
• Board Member
• Oregon Health Decisions

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OHD Public Participation Work

• Founded in 1982 to foster public participation
• Two projects prior to 1989 showed support for
  underlying ideas of Oregon Health Plan (OHP)
• Community Meetings as part of prioritization
  process for OHP
• Conducted 7 follow-up public engagement programs
  since launch of OHP.

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Public Input for Priorities List 1990

• 47 Community Meetings statewide
• 1048 Participants
• 13 community values identified
• 12 Public Hearings statewide
• Telephone survey Quality of Well-being Scale
  (modified)

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OHD Community Meetings

• Focus on the issue
• Small group discussion
• Make judgment
• Discuss values behind the judgment
• List core values
• Accumulate core values lists
• Combined lists for policy makers

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Community Values Identified

• Health Values
• Prevention
• Quality of Life
• Length of Life
• Mental Health and Chemical Dependency
• Ability to function
• Economic Values
• Effective treatment
• Cost effectiveness

• Social values
• Equity
• Benefits many
• Personal choice
• Impact on society
• Personal Responsibility
• Community compassion

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Input from the Public

• Clarify policy makers goals
• Solve representation problem
• Select method to fit goals
• Gather information?
• Build constituency?
• Educate?
• Focus on values
• Communicate relevant data to policy maker

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Methods of Participation

• Voting
• Advocacy/Protest
• Public hearings
• Community meetings
• Focus Groups
• Opinion Survey
• Public Conference
• Media Campaign
• Community Education

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Data from input

• Qualitative
• Provides context and texture of opinions
• aids insight into the problem and potential
  solutions
• Quantitative
• Provides information about distribution and
  intensity of opinions
• Aids insight into problem and potential solutions
• Predicts likely response to alternative
  solutions.

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Decision Phases1) Problem Structuring

• Distinguish Fact and Value Elements
• List Key Values
• Identify Assumptions
• Create Alternatives

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Decision Phases2) Constructing Policy

• Values ? Get from the public
• Facts ? Get from experts
• Alternatives ? Policy makers job

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Public Participation

• Constraints
• Fit political process
• Timing
• Level of concern
• Understanding of issues
• Barriers
• Weak sense of community
• Alienation from politics
• Cynicism

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Public Participation

• Creating the Prioritized list

Whats really important to us?
How can we make that happen?
Values fromcommunity
Facts from experts
The List