5028.0: Wednesday, November 15, 2000 - 8:50 AM

Abstract #6835

"Save the mother with cancer or help the father function with mental illness?": Investigating a deliberative mechanism to elicit public input on what to include in the Israeli national basic health services basket

Boaz Lev, MD, MPA1, Carmel Shalev, JD, PhD2, Nurit Guttman, PhD3, Jeffrey Borkan, MD, PhD4, and Rina Hakimian, JD, MPH2. (1) Office of the Associate Director General, Israel Ministry of Health, Rivka 29, Jerusalem, 91010, Israel, (2) Unit for Health Rights and Ethics, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, 52621, Israel, (3) Department of Communication, Tel-Aviv University and UMDNJ-Robert Wood Johnson Medical School, P.O.Box 39040, Tel-Aviv, 69978, Israel, 972-3-640-9010, guttman@post.tau.ac.il, (4) Sacker School of Medicine, Tel-Aviv University, Tel-Aviv, 69978, Israel

In Israel, as in other nations, the allocated budget for state-covered medications and technologies does not cover all existing and emerging new ones. The decision of what to include in the "basic basket of health services"--established under the 1995 National Health Insurance Law--and the need to update it are fraught with ethical dilemmas. Personal stories of patients vying for costly unincluded medications are featured prominently in the news media while advocacy groups mount public-relations campaign to pressure decision-makers. As problems inherent in updating the basic basket have become apparent, government officials, patient advocates, ethicists, scholars and journalists argue that public participation must be part of the process. Notable attempts to involve the public in rationing decisions have taken place in Sweden, Great Britain, New Zealand and the Netherlands; and in the U.S. in the state of Oregon, employing various methods including surveys, citizen juries, and public hearings. This paper reports on a research project that aims to develop a mechanism for the elicitation of population members' recommendations regarding what should be included in the health services basket and their underlying value-based justifications for these choices. The mechanism is based on a workshop-format designed to elicit values and ethical deliberations of diverse stakeholders, including members of minority and patient groups. The workshops are conducted nation-wide in diverse settings, ranging from community centers to work sites. The workshop format calls for two meetings that consist of a simulated case and a deliberation on medications/technologies that are under actual consideration.

Learning Objectives: Participants will be able to: Identify major ethical dilemmas associated with health care rationing Recognize different strategies emplyed in various nations to elicit public input into rationing policy decisions Assess alternatives public consultation methods and deliberative mechanisms

Keywords: Access and Services, Public Health Policy

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Israel Ministry of Health Health Policy Gertner Institue of Health Policy (Israel)
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA