Reluctant rationers : public input to health care priorities.
Members of the public can adopt any one of at least three roles when providing input to public decision-making : taxpayer, collective community decision-maker, or patient.
Each of these potential roles can be mapped onto three areas of public policy decision-making in health care : funding levels and organization for the system, the services we choose to offer under public funding, and the characteristics of those who should receive the offered services.
The increasing desire to involve the public across the spectrum of health care decision-making has yet to result in a clear delineation of either which of the areas are most appropriate for public input or which of the roles we wish individual participants to adopt.
The average citizen (as opposed to the self-interested patient, the provider or the manager) has so far shown little interest in contributing and rarely has the requisite skills for most of tasks asked of him or her.
The widespread motivation of governments and others for seeking public input appears to be get the public to take or share ownership in the tough rationing choices consequent on fiscal retrenchment in health care.
Evaluation of existing literature leads to the conclusion that there are only limited areas where we might wish to obtain significant public input if we adopt this widespread policy motivation. (...)
Mots-clés Pascal : Information, Santé, Organisation, Méthodologie, Protection sociale, Malade, Acteur, Hôpital, Service public, Secteur tertiaire, Secteur économique, Economie industrielle, Planification, Système santé, Politique sanitaire, Aide décision, Financement, Accessibilité, Soin, Choix, Priorité
Mots-clés Pascal anglais : Information, Health, Organization, Methodology, Welfare aids, Patient, Actor, Hospital, Public utilities, Tertiary activities, Economic sector, Industrial economy, Planning, Health system, Health policy, Decision aid, Financing, Accessibility, Care, Choice, Priority
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 21/07/1998.