Public Dialogues : A Strategy for Health System Reform

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.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

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

9. Perspectives on Equity Final Preference Score by Response to Equity Question 7.0 6.8 5.7 5.4 5.3 4.3 4.0 3.7 Scenario 1 Scenario 2 Scenario 3 Scenario 4 Comprehensive Comprehensive Limited Limited Private Public Private 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 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) “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)

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