1. Public Dialogues: A Strategy for Health System Reform AcademyHealth State Health Research & Policy Interest Group Meeting June 24, 2006 Jill Jamison Rissi St. Luke’s Health Initiatives Phoenix, AZ

2. Acknowledgements  ViewPoint Learning  Heidi Gantwerk  Isabella Furth, Ph.D.  Steven Rosell, Ph.D.  SLHI: www.slhi.orgwww.slhi.org

3. Why? To understand how people think about the healthcare system. To see how people’s preferences change as they become more informed. To understand what mediates the process of preference change. To develop more effective strategies for achieving reform.

4. Methodology and Process  Methodology  Four dialogues: three public, one with stakeholders  Random selection of public participants: Phoenix, Tucson & Flagstaff  Day-long, highly structured  Qualitative and quantitative measures

5. Methodology and Process  Process  Initial Judgment  Creating a vision for the future  Moving toward the envisioned future  Final judgment  Key insights  All videotaped

6. Why ChoiceWork Dialogues?  Political participation v. deliberation More ballot initiatives + More polls & surveys = Less deliberation  Internal and external validity Preference for alternatives + Random selection = Deliberative Public Opinion  Key to the “Black Box” is learning

7. Starting with Scenarios Employer-BasedPublic Comprehensive Scenario #1 Expand Employer- Based coverage with full coverage for all. Scenario #2 Create a Public System “Medicare for All.” Limited Scenario #3 Expand Employer- Based coverage with limited coverage for all. Scenario #4 Create a public system that provides the basics – the rest is up to you.

8. Rating the Scenarios Initialvs. Final Preference Scores 6.7 6.1 4.6 3.9 4.0 6.7 4.0 6.1 Scenario 1Scenario 2Scenario 3Scenario 4 Initial Final Comprehensive Private Comprehensive Public Limited Private Limited Public

9. Perspectives on Equity Final Preference Score by Response to Equity Question 4.0 7.0 3.7 5.7 4.3 5.4 5.3 6.8 Scenario 1Scenario 2Scenario 3Scenario 4 Comprehensive Private Comprehensive Public Limited Private Limited Public Ņ Everyone is entitled to the same level of health care Ņ Health care is like anything else you buy, those who can pay more should be able to get something better

10. Stakeholders and Next Steps  Engage the public directly in efforts to shape a universal system:  Online Dialogue  Meeting-in-a-Box  Phase-in a single universal system:  Start with kids…  Reform the educational system for healthcare providers:  Docs, nurses, other caregivers

11. Optimism for the Future “I was shocked when we went around the first time, I continue to be shocked as we finish up the day and very much invigorated. I am heartened by how much common wisdom there is on these issues.” (Stakeholder) “What I found most surprising is the vastness and complexity of this problem. I’m hoping that I will continue to learn and be able to a spokesperson out there to talk to people when there’s a need…. I think the best thing of all is that I love my state of Arizona and I’ve never seen so much public outreach before … your voice is heard here, and I think that’s a great start.” (Citizen) “I think I was most surprised by both the citizens’ conclusions and then our own consensus here today in general… I’ve been doing this a while, and I’m really kind of buoyed by today. This gives me a little staying power.” (Stakeholder)

12. Conclusion Multiple options Multiple perspectives Facts and Values Political Leverage Stability of Public Judgment Democracy