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Public Dialogues : A Strategy for Health System Reform. AcademyHealth State Health Research & Policy Interest Group Meeting June 24, 2006 Jill Jamison Rissi St. Luke’s Health Initiatives Phoenix, AZ. Acknowledgements. ViewPoint Learning Heidi Gantwerk Isabella Furth, Ph.D. - PowerPoint PPT Presentation
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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
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