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Article
Publication date: 22 November 2018

Peter Littlejohns, Katharina Kieslich, Albert Weale, Emma Tumilty, Georgina Richardson, Tim Stokes, Robin Gauld and Paul Scuffham

In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment…

Abstract

Purpose

In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process.

Design/methodology/approach

Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach.

Findings

A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool.

Research limitations/implications

The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience.

Practical implications

All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges.

Social implications

This study helps in increasing public involvement in complex health challenges.

Originality/value

No other groups have used this combination of approaches to address this issue.

Details

Journal of Health Organization and Management, vol. 33 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 15 August 2016

Albert Weale

Noting that discussions of public participation and priority setting typically presuppose certain political theories of democracy, the purpose of this paper is to discuss…

Abstract

Purpose

Noting that discussions of public participation and priority setting typically presuppose certain political theories of democracy, the purpose of this paper is to discuss two theories: the consensual and the agonistic. The distinction is illuminating when considering the difference between institutionalized public participation and contestatory participation.

Design/methodology/approach

The approach is a theoretical reconstruction of two ways of thinking about public participation in relation to priority setting in health care, drawing on the work of Habermas, a deliberative theorist, and Mouffe, a theorist of agonism.

Findings

The different theoretical approaches can be associated with different ways of understanding priority setting. In particular, agonistic democratic theory would understand priority setting as system of inclusions and exclusions rather than the determination of a consensus of social values, which is the typical deliberative way of thinking about the issues.

Originality/value

The paper shows the value of drawing out explicitly the tacit assumptions of practices of political participation in order to reveal their scope and limitations. It suggests that making such theoretical presuppositions explicit has value for health services management in recognizing these implicit choices.

Details

Journal of Health Organization and Management, vol. 30 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 15 August 2016

Albert Weale, Katharina Kieslich, Peter Littlejohns, Aviva Tugendhaft, Emma Tumilty, Krisantha Weerasuriya and Jennifer A Whitty

The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in…

Abstract

Purpose

The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue.

Design/methodology/approach

The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting.

Findings

The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation.

Originality/value

The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as “contestatory participation”. This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world.

Details

Journal of Health Organization and Management, vol. 30 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 15 June 2012

Peter Littlejohns, Kai Yeung, Sarah Clark and Albert Weale

The purpose of this paper is to demonstrate that the social values framework developed by Clark and Weale could be applied to publicly available data and to explore the…

Abstract

Purpose

The purpose of this paper is to demonstrate that the social values framework developed by Clark and Weale could be applied to publicly available data and to explore the concordance between the framework values and those present in the statements of decision‐making protocols of Health Technology Assessment Agencies.

Design/methodology/approach

The web sites of the National Institute for Health and Clinical Excellence (NICE); the All Wales Strategy Medicines Group; and the Scottish Medicines Consortium were searched for references to social value statements and assessed according to the social values framework.

Findings

The framework was easy to apply and demonstrated that it is possible to find statements of operational expression of a range of social values in the description of the decision protocols used by the public agencies. Most of the framework's values find some expression in the statements of the decision protocols, but there are differences. For example, the All Wales Group, when discussing clinical effectiveness, explicitly refers to an assessment via “pathways of care” in a way that neither of the other two do. The value of autonomy is explicitly mentioned by NICE but not by the other two, whereas the value of solidarity (a value most typically associated with European social insurance systems) finds only indirect expression in the guidance notes of all.

Practical implications

The paper provides further information that will be useful in revising the framework in preparation for its role in future data collection.

Originality/value

This is the initial step in developing a social values instrument that will support health policy decisions. While there are other check lists of social values, this is the first time that an approach to creating a framework is being tested empirically.

Details

Journal of Health Organization and Management, vol. 26 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 15 June 2012

Sarah Clark and Albert Weale

It is commonly recognized that the setting of health priorities requires value judgements and that these judgements are social. Justifying social value judgements is an…

Abstract

Purpose

It is commonly recognized that the setting of health priorities requires value judgements and that these judgements are social. Justifying social value judgements is an important element in any public justification of how priorities are set. The purpose of this paper is to review a number of social values relating both to the process and content of priority‐setting decisions.

Design/methodology/approach

A set of key process and content values basic to health priority setting is outlined, and normative analysis applied to those values to identify their key features, possible interpretations in different cultural and institutional contexts, and interactions with other values.

Findings

Process values are found to be closely linked, such that success in increasing, for example, transparency may depend on increasing participation or accountability, and “content” values are found often to be hidden in technical criteria. There is a complex interplay between value and technical components of priority setting, and between process and content values. Levels of economic development, culture and need will all play a part in determining how different systems balance the values in their decisions.

Originality/value

Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values is a more recent approach and one which this paper seeks to refine and develop.

Details

Journal of Health Organization and Management, vol. 26 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 15 August 2016

David James Hunter, Katharina Kieslich, Peter Littlejohns, Sophie Staniszewska, Emma Tumilty, Albert Weale and Iestyn Williams

The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest…

Abstract

Purpose

The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest that challenges emerge as a result of legitimacy deficits of both consensus and contestatory modes of public involvement in health priority setting.

Design/methodology/approach

The paper draws on the discussions and findings presented in this special issue. It seeks to bring the country experiences and case studies together to draw conclusions for policy, research and society.

Findings

At least two recurring themes emerge. An underlying theme is the importance, but also the challenge, of establishing legitimacy in health priority setting. The country experiences suggest that we understand very little about the conditions under which representative, or authentic, participation generates legitimacy and under which it will be regarded as insufficient. A second observation is that public participation takes a variety of forms that depend on the opportunity structures in a given national context. Given this variety the conceptualization of public participation needs to be expanded to account for the many forms of public participation.

Originality/value

The paper concludes that the challenges of public involvement are closely linked to the question of how legitimate processes and decisions can be generated in priority setting. This suggests that future research must focus more narrowly on conditions under which legitimacy are generated in order to expand the understanding of public involvement in health prioritization.

Details

Journal of Health Organization and Management, vol. 30 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 15 June 2012

Peter Littlejohns, Albert Weale, Kalipso Chalkidou, Ruth Faden and Yot Teerawattananon

This editorial aims to outline the context of healthcare priority‐setting, and summarise each of the other ten papers in this special edition. It introduces a new…

Abstract

Purpose

This editorial aims to outline the context of healthcare priority‐setting, and summarise each of the other ten papers in this special edition. It introduces a new multidisciplinary research programme drawing on ethics, philosophy, health economics, political science and health technology assessment, out of which the papers in this edition have arisen.

Design/methodology/approach

Key normative concepts are introduced and policy and research context provided to frame subsequent papers in the edition.

Findings

Common challenges of health priority‐setting are faced by many countries across the world, and a range of social value judgments is in play as resource allocation decisions are made. Although the challenges faced by different countries are in many ways similar, the way in which social values affect the processes and content of priority‐setting decisions means that those challenges are resolved very differently in a variety of social, political, cultural and institutional settings, as subsequent papers in this edition demonstrate. How social values affect decision making in this way is the subject of a new multi‐disciplinary research programme.

Originality/value

Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values and conducting comparative analyses across countries with very different cultural, social and institutional contexts provides the content for a new research agenda.

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Article
Publication date: 15 June 2012

Jeonghoon Ahn, Gaeun Kim, Hae Sun Suh and Sang Moo Lee

The purpose of this paper is to present the role of social values in setting healthcare priorities in Korea.

Abstract

Purpose

The purpose of this paper is to present the role of social values in setting healthcare priorities in Korea.

Design/methodology/approach

Using Clark and Weale's draft framework, Korean healthcare priority setting was analysed. The process values used were transparency, accountability, and participation, and the content values used were clinical effectiveness, cost effectiveness, justice/equity, solidarity and autonomy.

Findings

In the Korean health priority setting, it was found that multiple factors influence the decision‐making process. Effectiveness and safety are the two most important values mentioned in the process. Cost‐effectiveness is also considered in reimbursement decisions for new drugs since 2007. Recently, health technology assessment (HTA) has begun to change the social value system traditionally used in the Korean healthcare priority setting.

Originality/value

The paper extends understanding of health priority setting in Korea, and how the interpretation and use of social values has changed over recent years.

Details

Journal of Health Organization and Management, vol. 26 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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Book part
Publication date: 25 October 2011

The increasing trend towards sustainable development has seen a shift from ‘end of pipe solutions’ to the ongoing threat of pollution. Policy makers have come to accept…

Abstract

The increasing trend towards sustainable development has seen a shift from ‘end of pipe solutions’ to the ongoing threat of pollution. Policy makers have come to accept the need for some form of inbuilt environmental standards to be included in any overall planning strategy. These shifts come in the wake of the Brundtland Report and the Rio World Summit. They have also shaped environmental policy. A central feature of this new thinking is the theory of ‘Ecological Modernisation’ (EM). Underpinning this debate are the theorists Janicke, Weale and Hajer, who have each contributed to the conceptualisation of EM as a feature of modern society. It can be argued that EM theory reflects a critical new positioning of the environmental debate, moving away from the periphery of social, cultural and political channels and becoming an important aspect of policy planning in these areas.

Details

Community Campaigns for Sustainable Living: Health, Waste & Protest in Civil Society
Type: Book
ISBN: 978-1-78052-381-1

Abstract

Details

Journal of Health Organization and Management, vol. 30 no. 5
Type: Research Article
ISSN: 1477-7266

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