Health Planning in the United States Selected Policy Issues, Report of a Study, Volume I (1981) / Chapter Skim
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IV. Consumer Participation
IV. Consumer Participation
Pages 53-70
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From page 53... ...
History and Background An important characteristic of the health planning program is consumer participation. Health Systems Agencies (HSAs)
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From page 54... ...
to inform and involve the general public in the health planning process, presumably illustrating a genuine commitment to this activity as well as a desire to develop good will and credibility. Eighty-four percent of HSAs prepare and distribute newsletters reporting agency activities and current health issues, fifty percent maintain an extensive nailing list for distribution of newsletters and other agency documents.
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From page 55... ...
Department of Commerce, Bureau of the Census, Current Population Reports, Series P-60, No.
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From page 56... ...
Thus, while a governing body should accurately represent the community's consumers of health care, including the poor, the rural, and minorities so that their needs will be reflected in the agency's plans, the governing body should also include representation of newspaper editors, judges, bankers, third party payers, industry health professional schools and others who, once the plans are drawn up, can assist the agency in implementing them.
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From page 57... ...
The law's stipulation of governing board representation reflects a belief that the public interest will be served if all affected parties reach decisions and resolve differences through compromise. The law spells out which major demographic groups will be represented on the Doard, and precisely which providers must be included.
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From page 58... ...
Consumer groups, including the Public Citizen Health Research Group, the National Health Law Program, Georgia Legal Services, and the Consumer Coalition for Health, testified at various trials to many problems in the implementation of the consumer representation requirements. Witnesses documented instances of procedural gerrymandering, "elitist" self-selection, conflicts of interest, poor management, especially in relation to consumers, and violation of both the letter and the spirit of the law in some agencies.
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From page 59... ...
Perhaps most important in congressional hearings were challenges to the selection of USA governing body members. The 1974 law was silent on the question, and the boards were, in almost all cases, originally "self-selected." Planning agencies, mostly private and non-profit, incorporated themselves and applied to DHHS to be designated.
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From page 60... ...
Of unknown effect is a 1979 provision that government representatives can be either consumers or providers. The legislative history of the 1979 Amendments made suggestions for movement from the theoretically and operationally weak notion of descriptive representation (as discussed by Morone in Volume II of this study)
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From page 61... ...
Yet the planning legislation defines consumers primarily by demogrpahic characteristics and leaves unclear what the role of consumers is to be. Several observers have said that participation is a complex political notion, and there are more realistic ways to promote public participation than the methods mandated in the health planning legislation (Consumer Commission on the Accreditaiton of Health Services, Inc., 1978; Fullarton, 1978; Koseki and Hayakawa, 1979; Marmor and Morone, 1980; ~letsch and Veney, 1976~.
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From page 62... ...
Providers are most likely to resist demands for altering the present health care delivery system, and historically have mobilized political and economic support to lobby for their interests (Colt, 1970; Lipsky and Lounds, 1976; Detach and Veney, 1976~. Lack of Accountability and Appropriate Selection Processes The health planning le~islation's failure to provide for direct accountability of TISA governing board members is complicated by the differing definition of representation when applied to providers and consumers.
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From page 63... ...
annually asked constituent organizations to recertify that their appointee still represented their interests and thus remained "accountable." Fourteen percent of the agencies permit all governing body members to be directly appointed by local governmental authorities after appropriate solicitation of nominations from a broad range of sources. Such a process was regarded dubiously by one consumer group, which contended that local political systems have caused or perpetuated many of the difficulites in obtaining health care experienced by lowincome persons.
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From page 64... ...
Findings and Recommendations Consumer Participation The committee found that the health planning program is an enterprise aimed, among other goals, at more broadly distributing political power for advising on an area's health resources. TIealth planning attempts to remove decision making from provider domination and give the public more influence.
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From page 65... ...
The legislative history of the 1979 Amendments suggests a model of board composition that somewhat moves away from the mirror view embodied in the 1974 Act and toward more connections to interest groups. The concept of a consumer majority in health planning and planning as an arena for multiple interest bargaining are widely accepted.
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From page 66... ...
The results of the changed requirements have created a nation full of natural experiments with substantial diversity which can be used to impove our understanding of the factors that encourage effective consumer participation. The committee recommends that the Health Resources Administration take advantage of the diversity in the nation to evaluate different approaches to board selection, composition, and .
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From page 67... ...
Providers also need to learn about innovative and alternative service delivery, the importance of health promotion and disease prevention, consumer values, health economics, and the application of epidemiology to health planning. Training should cover many of these matters, as well as methods of decision making, leadership, and conflict resolution that can be employed by governing boards.
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From page 68... ...
Many of the problems of consumer participation might be reduced if citizens were paid for some documented preparation time and for attendance at governing body meetings and public hearings. The committee recognizes certain advantages to reimbursement for participation, but does not feel that a recommendation in favor of that idea is appropriate at this time.
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From page 69... ...
The committee also discussed the possibility of recommending requirements for more insurers and third party payers on governing bodies. Some of the committee felt strongly that third party payers, insurers, and other major health services purchasers should play major roles in health planning.
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From page 70... ...
-70Locations in which there are stron~ links between planning deci signs and third party payment should be studied. Locations where the board includes a larger proportion of payers, insurers or purchasers should also be studied to see whether or not there are differences in the effectiveness of these agencies.
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