Obtaining public input for health-systems decision-making: Past experiences and future prospects
Obtaining public input for health-systems decision-making: Past experiences and future prospects
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DOI：
10.1111/j.1754-7121.2002.tb01074.x
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发表时间：
2002-03-01
影响因子：
1
通讯作者：
Gauvin, FP
中科院分区：
文献类型：
--
作者：
Abelson, J;Forest, PG;Gauvin, FP
在加拿大，由于卫生保健决策的重要方面已从省级政府移交给地区卫生当局，人们比以往任何时候都更有兴趣寻找公众参与卫生系统决策的更有效方法。然而，让公众参与可能是一件有风险的事情，因为政府当局所做决定的问责制和合法性往往是根据与公众互动的性质和程度来评估的。因此，各种政策领域的决策者通常会纠结于这样的问题：什么时候让公众参与是合适的，什么是最有效的方法，以及如何衡量他们的成功。这组作者通过记录过去十年中加拿大两个省（安大略省和魁北克省）卫生系统决策者在公众咨询和参与下的经验分析了这些问题。他们的研究结果表明，尽管安大略省和魁北克省决策者的角色和责任不同，但与社区协商的决定是由相同的基本目标驱动的：从社区获取信息并向社区提供信息；确保公平、透明和合法的决策过程；并为他们的成果争取支持。决策者们还承认，有必要重新考虑让公众参与决策过程的办法，以回应过去公众参与和协商过程的明显失败。虽然这些经验显然使一些参与实践者感到被围困，但许多人正在乐观地接近未来的社区协商进程，并计划进行更集中、有目的的磋商，这些磋商有明确的目标和更正式的评估，并带有健康的实用主义色彩。
Interest in finding more effective methods for public involvement in decision-making about health systems is more widespread than ever in Canada since significant aspects of health-care decision-making were devolved from provincial governments to regional health authorities. Involving the public can be risky business, however, as the accountability and legitimacy of decisions made by governing authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision-makers in a variety of policy domains routinely struggle with questions about when it is appropriate to involve the public, what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health-systems decision-makers in two Canadian provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite the different roles and responsibilities held by Ontario and Quebec decision-makers, decisions to consult with their communities are driven by the same basic set of objectives: to obtain information from and to provide information to the community; to ensure fair, transparent and legitimate decision-making processes; and to garner support for their outcomes. Decision-makers also acknowledged the need to rethink approaches for involving the public in decision-making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching future community consultation processes optimistically with plans for more focused, purposeful consultations that have clear objectives and more formal evaluation tinged with a healthy dose of pragmatism.