Gavin Mooney DRS Sept 06

Whose health system is it anyway? Community engagement in determining health policy : 

Whose health system is it anyway? Community engagement in determining health policy DRS National Conference Adelaide 2006 Gavin Mooney Curtin University g.mooney@curtin.edu.au

Slide2: 

Who better than the people?

Who is the community?: 

Who is the community? Citizens not consumers

Values and Equity : 

Values and Equity It is not possible to define or pursue equity or efficiency without adopting a value or moral stance. These are ethical matters.

Why trust citizens?: 

Why trust citizens? Citizens are thick Citizens don’t care Citizens are ill-informed Citizens are biased Citizens just want the best Citizens just want machines that go ping Citizens are not charged with making decisions

Defining Equity in Health Care: 

Defining Equity in Health Care Equal health Equal access (for equal need) Equal use (for equal need)

WA Citizens’ Definition of Equity: 

WA Citizens’ Definition of Equity Equal access for equal need where equality of access means that two or more groups face barriers of the same height and where the judgment of the heights is made by each group for their own group; where need is defined as capacity to benefit; and where nominally equal benefits may be weighted according to social preferences such that the benefits to more disadvantaged groups may have a higher weight attached to them than those to the better off.

Two Types of Equity: 

Two Types of Equity Horizontal equity Equal treatment of equals Vertical equity Unequal but equitable treatment of unequals

What to do?: 

What to do? Listen to the people! Citizens’ juries Aboriginal health in South Australia

Broader Issues: 

Broader Issues Health care just one institution in a society Social values influence fairness in a society in general How can we build a more compassionate society? Whose values should drive equity in health care?

WA Citizens’ Jury 2000: 

WA Citizens’ Jury 2000 General principles Citizens from across the state What were their priorities? Equity Public health and prevention

WA Citizens’ Jury 2001: 

WA Citizens’ Jury 2001 Emphasis on equity Citizens from across the state Three areas of inequity: Aboriginal vs non Aboriginal Rural/remote vs Perth Aged care vs other

WA Citizens’ Definition of Equity: 

WA Citizens’ Definition of Equity Equal access for equal need where equality of access means that two or more groups face barriers of the same height and where the judgment of the heights is made by each group for their own group; where need is defined as capacity to benefit; and where nominally equal benefits may be weighted according to social preferences such that the benefits to more disadvantaged groups may have a higher weight attached to them than those to the better off.

WA Citizens’ Jury 2001: 

WA Citizens’ Jury 2001 Top priority? Aboriginal health Also Strong on vertical equity

South West AHS 2005: 

South West AHS 2005 Jury argued for More for disadvantaged groups especially Aboriginal (equity) More for prevention More for the mentally ill How to pay for above? Close/ redesignate small hospitals and EDs

Citizens’ Juries: 

Citizens’ Juries Can work! (Citizens quite amazingly enthusiastic) Need to be informed Need to be able to reflect Need to resource constrain choices Better at broad principles? NOT decision making

Citizens’ Juries: 

Citizens’ Juries Now worked with 4 Juries: ALL WANT MORE EQUITY!

Citizens’ Juries: 

Citizens’ Juries Great fun! (and for the citizens)