Abstract
Most countries appear to believe that their health system is in a state of semi-crisis with expenditures rising rapidly, with the benefits of many services unknown and with pressure from the public to ensure access to a comprehensive range of services. But whose values should inform decision-making in the health area, and should the influence of different groups vary with the level of decision-making? These questions were put to 54 members of the public and health professionals in eight focus groups. Adopting a different perspective from other studies, participants were not asked if particular groups should be involved in decisions but rather through deliberation and discussion nominated their own potential decision makers. This delivered a clear message that participants saw a legitimate role for a broad range of stakeholders in priority-setting decisions so as to incorporate a diversity of expertise and opinion. Companion themes were the acknowledgment that decisions involve ethical judgments and are not purely technical, that the power of special interest groups (such as clinicians) should be kept in check, and that the process by which decisions are reached is important. The results suggest that qualitative methods of investigation have the potential to improve the legitimacy of policy decisions by contributing to a better understanding of the values of the public and health professionals, and by expanding the range of options available for further research.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abelson, J., Forest, P., Eyles, J., Smith, P., Martin, E., & Gauvin, F. (2003) Deliberations about deliberative methods: Issues in the design and evaluation of public participation processes. Social Science and Medicine, 57(2), 239–251.
Abelson, J., Lomas, J., Eyles, S., Birch, S., & Veenstra, G. (1995). Does the community want devolved authority? results of deliberative polling in Ontario. Canadian Medical Association Journal, 153(4), 403–412.
Biggs A. (2004). Medicare: Background brief, Parliamentary Library of Australia E-Brief Online, Retrieved November 10, 2005, from http://www.aph.gov.au/library/intguide/SP/medicare.htm.
Bowling, A. (1996). Health care rationing: The public’s debate. British Medical Journal, 312(7032), 670–674.
Church, J., Saunders, D., Wanke, M., & Pong, R. (2002). Citizen participation in health decision-making: Past experience and future prospects. Journal of Public Health Policy, 23(1), 12–32.
Frankish, J., Kwan, B., Ratner, P., Higgins, J., & Larsen, C. (2002). Challenges of citizen participation in regional health authorities. Social Science and Medicine, 54(10), 1471–1480.
Freeman, S. (2000). Deliberative democracy: A sympathetic comment. Philosophy and Public Affairs, 28(4), 371–418.
Frohlich, N., & Oppenheimer, J. (1992). Choosing justice: An experimental approach to ethical theory. Berkeley: University of California Press.
Gutmann, A. (1993). Democracy. In R. Goodin, P. Pettit (Eds.), A companion to contemporary political philosophy (pp. 411–421). Oxford: Basil Blackwell.
Gutmann, A., & Thompson, D. (1996). Democracy and disagreement. Cambridge, Massachusetts: Harvard University Press.
Hoppe, M., Wells, E., Morrison, D., Gilmore, M., & Wilsdon, A. (1995). Using focus groups to discuss sentitive topics with children. Evaluation Review, 19(1), 102–114.
Hurworth, R. (1996). Qualitative methodology: Common questions about running focus groups during evaluations. Evaluation News and Comments, 5(1), 48–52.
Jordan, J., Dowswell, T., Harrison, S., Lilford, R., & Mort, M. (1998). Health needs-assessment: Whose priorities? Listening to users and the public. British Medical Journal, 316(7145), 1668–1670.
Krueger, R. (1988). Focus groups: A practical guide for applied research. London: Sage.
Krueger, R., & Morgan, D. (1998). The focus group kit. California: Thousand Oaks.
Lankshear, A. (1993). The use of focus groups in a study of attitudes to student nurse assessment. Journal of Advanced Nursing, 18, 1986–1989.
Litva, A., Coast, J., Donovan, J., Eyles, J., Shepherd, M., Tacchi, J., Abelson, J., & Morgan, K. (2002). The public is too subjective: Public involvement at different levels of health-care decision-making. Social Science and Medicine, 4(12), 1825–1837.
Miles, M., & Huberman, A. (1994). Qualitative data analysis. California: Thousand Oaks.
Morgan, D. (1988). Focus groups as qualitative research. London: Sage.
Morse, J. (2006). Advances in qualitative health research. Qualitative Health Research, 16(6), 739–740.
National Academy on an Aging Society (1999). Chronic conditions—a challenge for the 21st century. Challenges for the 21st century: Chronic and disabling conditions 1, 1–6.
Pettit, P. (1997). Republicanism. Oxford: Oxford University Press.
Pigden, C. (1989). Logic and the autonomy of ethics. Australasian Journal of Philosophy, 67(2), 127–151.
Powell, R., & Single, H. (1996). Focus groups. International Journal of Quality in Health Care, 8(5), 499–504.
Productivity Commission (2005). Economic implications of an ageing Australia. Research Report, Canberra.
Richardson J. (2002) Age weighting and time discounting: Technical imperatives versus social choice. In C. Murray, J. Salomon, C. Mathers, A. Lopez (Eds.), Summary measures of population health: Concepts, ethics, measurement and applications (pp. 663–76). Geneva: World Health Organisation.
Richardson, A., Charny, M., & Hanmer-Lloyd, S. (1992). Public-opinion and purchasing. British Medical Journal, 304(6828), 680–684.
Singer P. (1988) Ethical experts in a democracy. In: Rosenthal D, Shehadi F, (Eds.), Applied ethics and ethical theory (pp. 149–161). Salt Lake City: University of Utah Press.
Stronks, K., Strijbis, M., Wendte, J., & Gunning-Schepers, L. (1997). Who should decide? qualitative analysis of panel data from public, patients, healthcare professionals, and insurers on priorities in health care. British Medical Journal, 315(7100), 92–96.
Thompson, J. (1998). Discourse and knowledge: Defence of a collectivist ethics. London and New York: Routledge.
Torgenson, D., & Gosden, T. (2000). Priority setting in health care: Should we ask the tax payer? British Medical Journal, 320(7250), 1699.
Wailoo, A., & Anand, P. (2005). The nature of procedural preferences for health-care rationing decisions. Social Sciences and Medicine, 60(2), 223–236.
Weale A. (2003). Democratic values, public consultation and health priorities: A political science perspective. In A. Oliver (Ed.), Equity in health and healthcare (pp. 41–51). London: The Nuffield Trust.
White D. (2000) Consumer and community participation: A reassessment of process, impact and value. In G. Albrecht, R. Fitzpatrick, S. Scrimshaw (Eds.) Handbook of social studies in health and medicine (pp. 465–480). London: Sage.
Wiseman, V. (2005). Comparing the preferences of health professionals and members of the public for setting healthcare priorities—experiences from Australia. Applied Health Economics and Health Policy, 4(2), 129–137.
Wiseman, V., Mooney, G., Berry, G., & Tang, K. (2004). Involving the general public in priority setting: Experiences from Australia. Social Sciences and Medicine, 56(5), 1001–1012.
Wroe, D., & Wood, L. (2005) This 50-year old takes pills worth $25,000 a year. As his generation grows old, a massive health crisis looms. The Age, p. 14.
Zweifel, P., & Breyer, F. (1997). Health economics. New York & Oxford: Oxford University Press.
Acknowledgements
We would like to thank the reviewers for their very helpful comments.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McKie, J., Shrimpton, B., Hurworth, R. et al. Who Should be Involved in Health Care Decision Making? A Qualitative Study. Health Care Anal 16, 114–126 (2008). https://doi.org/10.1007/s10728-007-0051-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10728-007-0051-y