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Oregon Health DecisionsCommunity Meetings Process

Michael J. Garland, D. Sc. Rel.

Professor Emeritus

Public Health and Preventive Medicine

Senior Scholar

Center for Ethics in Health Care

Oregon Health & Science University

Board Member

Oregon Health Decisions

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OHD Public Participation Work

• Founded in 1982 to foster public participation • Two projects prior to 1989 showed support for

underlying ideas of Oregon Health Plan (OHP)• Community Meetings as part of prioritization

process for OHP• Conducted 7 follow-up public engagement

programs since launch of OHP.

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Public Input for Priorities List 1990

• 47 Community Meetings statewide

– 1048 Participants

– 13 community values identified

• 12 Public Hearings statewide

• Telephone survey Quality of Well-being Scale (modified)

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OHD Community Meetings

• Focus on the issue• Small group discussion

1. Make judgment2. Discuss values

behind the judgment3. List core values

• Accumulate core values lists• Combined lists for policy makers

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Community Values Identified• Health Values

– Prevention– Quality of Life– Length of Life– Mental Health and

Chemical Dependency– Ability to function

• Economic Values– Effective treatment– Cost effectiveness

• Social values– Equity

– Benefits many

– Personal choice

– Impact on society

– Personal Responsibility

– Community compassion

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Input from the Public

• Clarify policy maker’s goals• Solve representation problem• Select method to fit goals

• Gather information?• Build constituency?• Educate?

• Focus on values• Communicate relevant data to policy maker

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Methods of Participation

• Voting• Advocacy/Protest• Public hearings• Community meetings• Focus Groups• Opinion Survey• Public Conference• Media Campaign• Community Education

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Data from input

• Qualitative – Provides context and texture of opinions– aids insight into the problem and potential solutions

• Quantitative– Provides information about distribution and intensity of

opinions– Aids insight into problem and potential solutions– Predicts likely response to alternative solutions.

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Decision Phases

1) Problem Structuring• Distinguish Fact and Value Elements

• List Key Values

• Identify Assumptions

• Create Alternatives

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Decision Phases

2) Constructing Policy

• Values Get from the public

• Facts Get from experts

• Alternatives Policy makers’ job

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Public Participation

• Constraints• Fit political process

• Timing

• Level of concern

• Understanding of issues

• Barriers• Weak sense of community

• Alienation from politics

• Cynicism

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Public Participation Creating the Prioritized list

Values fromcommunity

Facts from experts

The List

How can we make that happen?

What’s really important

to us?