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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Carmel Shalev, JD, PhD, Unit for Health Rights and Ethics, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, 52621, Israel, Boaz Lev, MD, MPA, Office of Director General, Israel Ministry of Health, Jerusalem, Israel, Nurit Guttman, PhD, Department of Communication, Tel-Aviv University, Tel-Aviv, 69978, Israel, 972-3-640-9010, carmels@gertner.health.gov.il, and Jeffrey Borkan, MD, PhD, Brown Medical School/Memorial Hospital of RI, 111 Brewster Street, Pawtucket, RI 02860.
Background: Various methodologies to elicit public views on healthcare priorities are used in different countries. An important challenge is to develop methods that provide adequate information and enable reflection and deliberation. Israel’s annual updating of its national health services basket--currently conducted mainly by experts-- is a prime case for eliciting the perspective of the public.
Objective: To develop a consultation methodology that involves members of diverse groups and elicits informed and considered opinion regarding difficult rationing choices.
Methods: A two-session workshop, featuring simulation activities and case exemplars to introduce and underscore ethical considerations, was developed and tested. Participants were provided with information on laws, policies and prototype treatments that were actual candidates for the basket.
Setting: Sessions took place in a variety of urban and rural sites that were natural and convenient for participants.
Participants: 26 groups recruited from various communities, including vulnerable groups, patient advocates, new immigrants, ethnic minorities and health professionals.
Results: Participants found the experience daunting, yet representing true democracy. They identified ethical issues, moved from utility to other considerations, and considered factors such as cost to the individual rather than only cost to the system. Greater weight was attributed to services that improve quality of life than to those that prolong it. The deliberation produced a shift and distillation of individual and group prioritization.
Conclusions: Despite limitations, the format enabled elicitation of informed and deliberated opinions from diverse groups and consideration of underlying values. It provides a community-centered approach for public consultation in healthcare decisions.
Learning Objectives:
Presenting author's disclosure statement:
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.