What is the point of citizen participation in health care? (original) (raw)
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Citizens participation in healthcare: a fruitful opportunity or a populist ethic idea?
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The rapid increase of life expectancy in Europe is a positive outcome related to improved health care and to socioeconomic progress. But increased life expectancy entails higher costs. Thus, governments are forced to rationalize health services and point to new technologies. However, generally, health planning, care programming and expenditure controls don’t regard citizens’ involvement. The paper aims to tackle the following question: could participation processes aid to make more effective decision in health care and contribute to produce less expensive outcomes? Citizens participation is a political principle universally recognized as a civil right, and many researchers have claimed that citizens involvement in health decision-making allows advantages. Our opinion is that citizen participation in health care presents some peculiarities if compared to the classic participatory models developed for environmental impact assessment or for urban planning processes. After an analysis o...
Public Participation in Health: Making People Matter
1999
Participation of communities is widely argued to be an important factor in improving health outcomes and the performance of health systems. This paper uses a review of past experience of participation in Zimbabwe's health system to propose that participation be strengthened along two dimensions: Creating realistic expectations between communities and health services in their contributions towards health, and in the governance of health systems. Various examples are outlined of the relationship between social participation and control and health outcomes. The paper also outlines the features of and factors in building participation in governance of health systems. It argues for a wider inclusion of social groups from civil society, elected leadership and health systems in structures and processes that set and audit health policies and priorities. It discusses issues to be addressed in enhancing participation, including the information, processes, capacities and resources required. Finally, it reviews the proposals for and issues to be addressed in enhancing participation and accountability in Zimbabwe's health sector at district, referral hospital and national level.
Opening the black box of participation in medicine and healthcare
This paper unpacks the notion of public and patient “participation” in medicine and healthcare. It does so by reviewing a series of papers published in the British Medical Journal, and by discussing these in the light of scholarship on participation in political and social theory. We find that appeals to public participation in this series are based on a diverse, potentially contradictory, set of values and motivations. We argue that if these diverse values and motivations are not carefully distinguished, appeals to participation can be an impediment, rather than an enhancement, to greater transparency and public accountability of health research.
Public involvement in healthcare is a prominent policy in countries across the economically developed world. A growing body of academic literature has focused on public participation, often presenting dichotomies between good and bad practice: between initiatives that offer empowerment and those constrained by consumerism, or between those which rely for recruitment on self-selecting members of the public, and those including a more broad-based, statistically representative group. In this paper I discuss the apparent tensions between differing rationales for participation, relating recent discussions about the nature of representation in public involvement to parallel writings about the contribution of laypeople’s expertise and experience. In the academic literature, there is, I suggest, a thin line between democratic justifications for involvement, suggesting a representative role for involved publics, and technocratic ideas about the potential ‘expert’ contributions of particular subgroups of the public. Analysing recent policy documents on participation in healthcare in England, I seek moreover to show how contemporary policy transcends both categories, demanding complex roles of involved publics which invoke various qualities seen as important in governing the interface between state and society. I relate this to social-theoretical perspectives on the relationship between governmental authority and citizens in late-modern society.
Introduction: This paper synthesises reports on community participation (CP) concept and its practicability in countries' health service systems, much focus being on developing countries. Methodology: We narratively reviewed the published and grey literature traced from electronic sources and hard copies as much as they could be accessed. Findings: CP is a concept widely promoted, but few projects/programmes have demonstrated its practicability in different countries. In many countries, communities are partially involved in one or several stages of project cycles -priority setting, resource allocation, service management, project implementation and evaluation. There is tendency of informing communities to implement the decisions that have already been passed by elites or politicians. In most of the project/programmes, professionals dominate the decision making processes by downgrading the non-professionals or non-technical people's knowledge and skills. CP concept is greatly...
Which champions, which people? Public and user involvement in health care
1998
This paper concerns two practices, public consultation and user involvement, whose adoption has been urged upon the UK National Health Service in recent years. Public consultation is a local attempt to seek the views of a broad constituency of persons. User involvement is a local attempt to include organized groups of service users in the planning, and occasionally the management, of such services. The paper has four objectives. First, it locates the topic in the context of several related current debates. Second, it outlines the main findings of a recent empirical study of public consultation as they relate to the above debates. Third, it summarizes the relevant findings of an empirical study of user involvement. Finally, it examines these two practices as "technologies of legitimation" which can be seen as a means by which managerial legitimacy is maintained in the context of an increasingly pluralistic policy arena.
Public Participation in the New NHS: No Closer to Citizen Control?
Social Policy & Administration, 2002
Over the last decade support for increasing public participation in decisions regarding the planning and delivery of health services has become a familiar feature of the policy agenda for the UK National Health Service. This paper reviews current Labour policy towards public participation and reports on the response of primary care groups (PCGs) to recent Labour directives to make patient and public involvement an integral part of the way they work, presenting the findings of a survey conducted in one English health region. The experience of these PCGs suggests that, despite the diverse backgrounds of board members, there is marked consensus between local and central decision makers as to their understanding of public participation. Whilst academic debates have tended to conceptualize participation in dualist terms as a form of consumerism or of citizenship, the survey data suggest that in the context of local implementation public participation is framed within a new public management perspective which values it as an aid to organizational learning. The findings of this study highlight obstacles to securing effective public participation, including a lack of substantive guidance regarding policy implementation that produces uncertainty amongst local decision makers as to how best to proceed. The inherent limitations of public participation within the new public management paradigm suggest that democratic renewal, one of the goals of the government's modernization agenda, is unlikely to be achieved.