Involving Consumers in Health Care Decision Making
HEALTHCAREANALYSIS VOL.3:196-204 (1995)
c
Phil Shackleyand Mandy Ryan
Health Economics Research Unit, University of Aberdeen, Scotland Abstract
This paper considers ways of involving consumers in decisions regarding the allocation of scarce health service resources. Specifically, two levels of consumer participation are highlighted and discussed. These are: (1) at the level of deciding whether or not a particular service should be introduced or its scale changed; and (2) at the level of deciding how best to provide a service once it has been decided that the service will be provided. The limitations of the current methods of involving consumers are outlined and two alternative approaches discussed. These are willingness to pay and conjoint analysis.
Introduction
Limited resources coupled with unlimited d e m a n d for health care mean that decisions have to be m a d e regarding the allocation of scarce resources across competing health care interventions. Traditionally, the extent of consumer (patient) involvement in this decision making process has been minimal. However, with the advent of the recent reforms of the UK National Health Service (NHS), greater consumer involvement has been advocated. 1-3 A policy emphasis on increasing patient choice and the implication that this is a good thing indicates that the UK government envisages consumers in the 'new ' NHS as having a m u c h more active role in health care decision making. Although the background to this paper is the recent reforms of the UK National Health Service, the concepts discussed are relevant to any health care system in which community values a n d / o r patient preferences are elicited. In this p a p e r w e consider ways of involving consumers in decisions regarding the use of
scarce health care resources. Consumer involvement is considered at two distinct levels. The first concerns decisions about w h e t h e r or not a particular service should be introduced or its scale changed
c
Phil Shackleyand Mandy Ryan
Health Economics Research Unit, University of Aberdeen, Scotland Abstract
This paper considers ways of involving consumers in decisions regarding the allocation of scarce health service resources. Specifically, two levels of consumer participation are highlighted and discussed. These are: (1) at the level of deciding whether or not a particular service should be introduced or its scale changed; and (2) at the level of deciding how best to provide a service once it has been decided that the service will be provided. The limitations of the current methods of involving consumers are outlined and two alternative approaches discussed. These are willingness to pay and conjoint analysis.
Introduction
Limited resources coupled with unlimited d e m a n d for health care mean that decisions have to be m a d e regarding the allocation of scarce resources across competing health care interventions. Traditionally, the extent of consumer (patient) involvement in this decision making process has been minimal. However, with the advent of the recent reforms of the UK National Health Service (NHS), greater consumer involvement has been advocated. 1-3 A policy emphasis on increasing patient choice and the implication that this is a good thing indicates that the UK government envisages consumers in the 'new ' NHS as having a m u c h more active role in health care decision making. Although the background to this paper is the recent reforms of the UK National Health Service, the concepts discussed are relevant to any health care system in which community values a n d / o r patient preferences are elicited. In this p a p e r w e consider ways of involving consumers in decisions regarding the use of
scarce health care resources. Consumer involvement is considered at two distinct levels. The first concerns decisions about w h e t h e r or not a particular service should be introduced or its scale changed
References: 1. Secretaries of State for Health, Wales, Northern Ireland and Scotland (1989). Working for Patients, HMSO, London. 2. Secretaries of State for Health, Wales, Northern Ireland and Scotland (1989). Promoting Better Health, HMSO, London. 3. Secretary of State for Health (1991). The Health of the Nation, HMSO, London. 4. NHS Management Executive (1992). Local Voices. The Views of Local People in Purchasing for Health, NHSME, London. 5. Groves, T. (1993). Public disagrees with professionals over NHS rationing. British Medical Journal 306, 673. 6. Bowling, A., Jacobson, B. and Southgate, L. (1993). Health service priorities: explorations in consultation of the public and health professionals on priority setting in an inner London health district. Social Science and Medicine 37, 851-857. 7. Donaldson, C. (1993). Theory and Practice of Willingness to Pay for Health Care. Discussion Paper 01/93, Health Economics Research Unit, University of Aberdeen. 204 R SHACKLEYAND M. RYAN 8. Donaldson, C., Walker, A., Farrar, S. and Mapp, T. (1994). Community Values in Child Health Services: An EconomicApproach. Report to Grampian Health Board, Health Economics Research Unit and Department of Public Health, University of Aberdeen. 9. Olsen, J.A. and Donaldson, C. (1993). Willingness to Pay for Public Sector Health Care Programmes in Northern Norway. Discussion Paper 05/93, Health Economics Research Unit, University of Aberdeen. 10. Hall, J. and Dornan, M. (1988). What patients like about their medical care and how often they are asked: a meta-analysis of the satisfaction literature. Social Science and Medicine 22, 935939. 11. Scottish Office (1992). The Patient 's Charter: What Users Think 1992. HMSO, Edinburgh. 12. Heyden, V. (1993). Never mind the quantity. Health Service Journal 103(5352), 21. 13. Cattin, P. and Wittink, D. (1982). Commercial use of conjoint analysis: a survey. Journal of Marketing 46, 44-53. 14. Journal of Transport Economics and Policy (1988). 22 (whole issue). 15. Brunel University (1993). The Valuation of Changes in Quality in the Public Services. Report prepared for H.M. Treasury, HMSO, London. 16. Ryan, M. (1992). Stated Preference: A Method for Establishing the Nature of the Patient 's Utility Function. Discussion Paper 14/92, Health Economics Research Unit, University of Aberdeen. 17. Ryan, M. and Farrar, S. (1994). Using Conjoint Analysis to Establish the Views of Users in the Provision of Orthodontics in Grampian. Discussion Paper 07/94, Health Economics Research Unit, University of Aberdeen. 18. Donaldson, C. (1994). Distributional issues in willingness to pay. Unpublished paper. 19. Donaldson, C., Shackley, P., Abdalla, M., Miedzybrodzka, Z. and Semper, J. (1994). The Use of Willingness to Pay Alongside Randomised Trials. Discussion paper 01/94, Health Economics Research Unit, University of Aberdeen. 20. Kind, P., Rosser, R. and Williams A. (1983). Valuation of quality of life: some psychometric evidence. In, Value of Life and Safety, ed. by M.W. Jones-Lee, North-Holland, Amsterdam.