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Enhancing Citizen Involvement in Health System Reform: Strategies and Outcomes**

This document explores the growing trend of citizen involvement in health system reforms. It discusses various strategies such as public information, advocacy, formal representation, and patient rights legislation aimed at enhancing public engagement in health services. Key questions addressed include whether these strategies lead to increased responsiveness and improved health service outcomes. The findings indicate that while strategies to involve patients are expanding, their overall impact on service quality remains uncertain. Emphasis is placed on the importance of accountability and informed choice in shaping effective health systems.

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Enhancing Citizen Involvement in Health System Reform: Strategies and Outcomes**

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  1. Citizen involvementand health system reform Josep Figueras European Health Forum Gastein 5th October 2005

  2. Are health system reforms increasing citizen involvement? • What are the available strategies? • Do they make a difference in the outcome (including responsiveness) of the health services?

  3. Citizen involvement / Strategies • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005)

  4. Citizen involvement / StrategiesVoiceand Exit • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005)

  5. Citizen involvement / StrategiesVoiceand Exit • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005)

  6. Citizen involvement / Strategies Public / Citizen / Patient Collective - Public • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005) Individual - Citizen Individual - Patient

  7. Citizen involvement / Strategies Areas of involvement Priority setting • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005) Planning Delivery

  8. Satisfaction with the health care system In Busse et al. (2005) Sources: (A) Pescosolido et al. 1985; (B) Blendon et al. 1990, # Blendon et al. 1991; (C) Blendon et al. 1995; (D), (F) (G) (H) Eurobarometer, Mossialos, Figueras et al. 2004, (E) & (I) Blendon et al. 2002 ; (J) OECD 2005; (K) Harris poll 2004

  9. Overall levels of responsiveness WHO 2000-2001 Survey Source: Valentine et al (2003)

  10. Stockholm network 2004

  11. Formal representation • HTA / Setting the benefit package • E.g. Germany: federal joint committee; UK NICE • Insurers / purchasers • In all SHI: representation in sickness funds boards • Primary care and hospital providers • E.g. Patient forums in NHS trusts in the UK • Whose representatives? • Dominance of medical & managerial elites?

  12. Patients rights • Statutory establishment of packages of care • Patient charters /laws: access, treatment coverage • E.g. guarantees on waiting times and opting out • Complaints mechanisms • Ombudsperson • Backed by legal / financial sanctions?

  13. Thomson and Dixon, EuroObserver 2004

  14. Responsiveness Efficiency Access

  15. Opportunities for choice Score: 1 (very bad) 2 (bad), 3 (moderate), 4 (good) 5 (very good) Source: Coulter & Jenkinson (2005)

  16. Levels of choice WHO 2000-2001 Survey Source: Valentine et al (2003)

  17. Reforms to increase choice • Choice of sickness funds in SHI countries • Belgium, Switzerland, Germany, The Netherlands • Choice of hospital providers in NHS type systems in UK, Northern and Mediterranean countries • Sufficient information / benchmarking? • Trade offs with equity and efficiency? • Inverse participation law (R. Klein)

  18. Citizen involvementConcluding points • Increasing number and range of strategies • Impact on health sytems Involving patients has contributed to changes in the provision of services accross a range of settings but the effects of this process on the quality and effectiveness of services is unknown. Crawford et al 2002.

  19. Citizen involvementConcluding points • Voice mechanisms have a limted impact • However key role of accountability, legal and financial sanctions in increasing impact • Exit (choice) strategies have larger impact, but equity and efficiency trade offs

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