Essential Health Benefits Balancing Coverage and Cost (2012) / Chapter Skim
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6 Public Deliberation
6 Public Deliberation
Pages 103-114
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From page 103... ...
THE PUBLIC VOICE In considering how best to capture the public voice in meaningful ways for the determination of the EHB package, this section explores the potential roles of the public, offers guidance to ensure that public processes are reasonable, and defines the value of public deliberation as a distinct approach that incorporates choices among covered benefits and benefit design in a prioritized fashion. In recent years there has been growing emphasis on patient engagement in health care -- helping individual patients become more active in health promotion and self-care, and encouraging a partnership with their physicians and other providers in planning for the services they receive.
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From page 104... ...
. Further opportunities for public input in the service coverage determination process exist, as illustrated in the case of health technology assessment for Medicare decisions as well as in Oregon and Washington State (Table 6-1)
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From page 105... ...
b Chalkidou et al., 2009; CMS, 2003, 2006a,b,c; ISPOR, 2011; Washington State Health Care Authority, 2007a. c Oregon Health Resources Commission, 1994, 2006.
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From page 106... ...
The publicity condition exposes the rationales of decision makers. These components are reflected in the recommendations of this committee, which also recognizes that the general public must be part of that "broad range of stakeholders in decision making." Why Public Deliberation?
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From page 107... ...
integrat ing transparency and accountability. Specifying the Issues for the Public to Address Public deliberation processes can be applied to a wide variety of coverage, policy, and practice issues.
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From page 108... ...
Although the target groups for deliberative participation are typically those most likely to be subject to the coverage limits, other stakeholders can benefit by observing the deliberative sessions or being participants in
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From page 109... ...
The success of the EHB structure will depend to a large extent on trust by the public -- as those whose insurance is defined by the EHB, as taxpayers, and as interested and concerned citizens -- and this trust will be damaged if deliberation is viewed as window-dressing. Building public deliberation into the EHB process can also contribute to public understanding of the need to make tough choices about the allocation of health care resources.
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From page 110... ...
However the most noteworthy use of public deliberation to help inform new health care policy was in Oregon in 1989. Oregon Health Plan As part of the Oregon Health Plan to expand Medicaid to more Oregon residents, Oregon's Senate Bill 27 of 1989 required the Health Services Commission to "actively solicit public involvement by a community meeting process."2 The architects of the plan recognized that defining a "basic" level of care "must be based on criteria that are publicly debated, reflect a consensus of social values, and consider the good of society as a whole" (DHS, 2006, p.
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From page 111... ...
opened up opportunities for employers to engage their employees in priority setting for health plan benefits. The early 2000s brought rapidly rising premiums, and anx ious employers were seeking ways both to educate their employees about the challenges of maintaining affordable health coverage and to gain input on the coverage issues that were especially critical to them.
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From page 112... ...
and governance of the state health insurance exchanges need to ensure that the consumer or citizen voice is an active one in the development, operations, and evaluation of the EHB. This may be best achieved through public deliberation, advisory committees, and/or other means of public input and participation.
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2010. Experience in the United States with public deliberation about health insurance benefits using the small group decision exercise, CHAT.
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2011. Role of patient and public participation in health technology assessment and coverage decisions.
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