The Art of the Possible: Getting Thoughtful and Constructive Public Views on Thorny Health Policy Issues 

Friday, April 22, 2016
Jill Yegian

The U.S. health care system’s complexity, coupled with the inherently emotional and personal nature of health care, often makes it difficult for policymakers to hear informed public voices on complex issues. Yet, the policy goal of high-quality, affordable patient-centered care will likely remain out of reach without thoughtful and constructive public input on how to balance individual preferences with broader societal concerns.

Two studies out this month illustrate that engaging the public to provide informed views about complex health care topics is hard work but not impossible. Both studies used an innovative way—known as public deliberation—to gather knowledgeable public perspectives on complex issues like the role of medical evidence in treatment decisions and what strategies are most acceptable to reduce harmful and wasteful care.

The first study, from the American Institutes for Research and published in the April Health Affairs, explored how deliberation can increase public understanding of medical evidence and advance acceptance of evidence-based care.  Titled “Understanding an Informed Public’s Views on the Role of Evidence in Making Health Care Decisions,” the study found that when people had the opportunity to learn about and discuss medical evidence through deliberation, their views shifted to give more weight to medical evidence in treatment decisions and less to patient preferences.

Unlike surveys and focus groups that collect top-of-mind views, deliberation encourages people to learn about an issue and consider alternative—often competing—perspectives. Deliberation has three main pieces:  educate in a neutral, objective way; consider all sides of an issue; and encourage balance of broader societal concerns with individual points of view.

Closer to home, the Sacramento-based Center for Healthcare Decisions issued a new report—Doing What Works—finding that  once people grasp the magnitude of the problem of harmful and wasteful care, they are more willing to support steps to curtail unneeded care through greater physician oversight and possibly increased patient cost sharing.  

The Doing What Works project also used deliberation to gather public input. CHCD conducted 10 intensive half-day deliberative sessions from September to December 2015 with 117 California residents with Medi-Cal coverage, as well as lower-to-middle income health plan members from Covered California and CalPERS, to answer the question: “What strategies are most acceptable for reducing the use of medical care that is harmful and/or wasteful?”

In 2015, California’s three largest health care purchasers—the state Department of Health Care Services (DHCS), which administers Medi-Cal; Covered California, the state’s health insurance marketplace; and the California Public Employees Retirement System (CalPERS)—formed the Statewide Workgroup on Reducing Overuse with an explicit mandate to gather public input on ways to reduce harmful or wasteful care.  

Along with providing technical assistance to the Workgroup on Overuse, the Integrated Healthcare Association (IHA) is working to advance evidence-based care through the Choosing Wisely ® campaign to reduce overuse of antibiotics for adult bronchitis, diagnostic testing for low back pain and other commonly overused services.

The results of the Doing What Works project will help inform both the Workgroup on Reducing Overuse and IHA’s Choosing Wisely project to identify ways to balance patient choice and physician autonomy against the larger societal concerns of preventing harm and wasting finite resources.


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