1. 1 Oregon Health Decisions Community 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

2. 2 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.

3. 3 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)

4. 4 OHD Community Meetings Focus on the issue Small group discussion 1.Make judgment 2.Discuss values behind the judgment 3.List core values Accumulate core values lists Combined lists for policy makers

5. 5 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

6. 6 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

7. 7 Methods of Participation Voting Advocacy/Protest Public hearings Community meetings Focus Groups Opinion Survey Public Conference Media Campaign Community Education

8. 8 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.

9. 9 Decision Phases 1) Problem Structuring Distinguish Fact and Value Elements List Key Values Identify Assumptions Create Alternatives

10. 10 Decision Phases 2) Constructing Policy Values  Get from the public Facts  Get from experts Alternatives  Policy makers’ job

11. 11 Public Participation Constraints Fit political process Timing Level of concern Understanding of issues Barriers Weak sense of community Alienation from politics Cynicism

12. 12 Public Participation Creating the Prioritized list Values from community Facts from experts The List How can we make that happen? What’s really important to us?