Presentation on theme: "S HOULD WE MAKE THE PRIORITY SETTING PROCESS MORE EXPLICIT TO THE PUBLIC ? D R B ENEDICT R UMBOLD."— Presentation transcript:
S HOULD WE MAKE THE PRIORITY SETTING PROCESS MORE EXPLICIT TO THE PUBLIC ? D R B ENEDICT R UMBOLD
P AY NO ATTENTION TO THE MAN BEHIND THE CURTAIN ! At present, priority setting process is semi-public; the curtain has been drawn back, but not completely. The public are aware that priority setting takes place but not: – Who is responsible for decision making – What basis decisions are made on We need to decide whether to either: a)Make the process more transparent b)Publicly endorse an obscurity – be explicitly implicit (Chinitz, 1998) Toto reveals the Wizard - The Wizard of Oz (1939)
C URRENT PRACTICE IN THE E NGLISH N ATIONAL H EALTH S ERVICE Questionnaires sent out to all 152 Primary Care Trusts in England. 115 responses from 74 out of 152 PCTs (49%). Survey results suggest that 70% of PCTs have a formal priority setting boards. Respondents asked to highlight which aspects of the priority setting process PCTs make available to the public.
Q UESTION : W HICH OF THE FOLLOWING ASPECTS OF THE PRIORITY SETTING PROCESS DOES YOUR PCT MAKE EXPLICIT TO THE PUBLIC ?
W HY DO PRIORITY - SETTERS MAKE THE PROCESS SO UNCLEAR ? Interviews yet to take place – but working hypothesis is they want to avoid blame. But what is blame and why are priority-setters so concerned about it? Blame: – Perception of harm – Perception of responsibility Worry of priority-setters is that, by its very nature, priority- setting involves causing harm – e.g. by denying healthcare to people who would benefit from it. So, blame is seen as inevitable, hence their interest in strategies of blame-avoidance (especially limiting perceptions of responsibility).
Hood suggests blame can: Encourage decision-makers to win the argument. Improve the delegation of responsibility within decision-making hierarchies. Encourage decision-makers to follow set rules and processes – to take care. (Hood, 2010) P UBLICITY CAN BE GOOD, EVEN IF IT MEANS MORE BLAME National Library NZ
COMPLETE PUBLICITY HAS COSTS Complete publicity can negatively effect the decision-making process: – Moving from private, particularistic reasons to truly public reasons may then often have an associated price, i.e., shifting from profound (private) reasons to shallow or manipulative (public) reasons (Chambers, 2004). Also, complete publicity rarely allows for vagueness, and vagueness in the priority- setting process may not only be necessary but also something we want to hang on to (e.g. Mechanic, 1997). The villagers confront Frankenstein – Frankenstein (1931)
R EFERENCES Chambers, S (2004) Behind Closed Doors: Publicity, Secrecy, and the Quality of Deliberation, Journal of Political Philosophy 12(3): 389-410 Chinitz, D., Shalev, C., Galai, N. & Israeli, A. (1998) Israels basic basket of health services: the importance of being explicitly implicit, BMJ, 317, 1003-7 Hood, C (2010) Risk and Government: The architectonics of blame-avoidance, Darwin College Lecture Series - February 2010 Mechanic, D., (1997), Muddling Through Elegantly: Finding the proper balance in rationing, Health Affairs 16 (5) 83-92. Weaver, R K (1986) The Politics of Blame Avoidance Journal of Public Policy 6 (4): 371-98.