Health care priorities: the community's preferences for using community preferences

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Determining how health care resources should be allocated - often termed rationing or priority setting - has traditionally been carried out by health care personnel, usually doctors but increasingly managers. More recently there has been a move to involve the general public in this process. Much of the research in this area has focussed on the methods used to elicit community preferences. While this is an important area of investigation, a prior issue of how community members feel about the use of their preferences in informing health care priorities needs to be investigated. Four specific questions will be addressed in this study: (i) do members of the general public feel that, as individuals, they have a legitimate role to play in informing priority decisions in health care? if so why? if not, why not? (ii) does the nature-level-setting of the decisions for which priorities are to be set affect whether individual members of the public would wish to participate in the priority setting process? (e.g. different health services, medical procedures-treatments, diseases) (iii) whose preferences should be used if not the community's? (iv) faced ex post with the preferences of the community and the preferences (possibly different) of health service decision makers (i.e. Oexperts'), does this knowledge affect preferences for having community preferences count? A number of health authorities are currently looking for ways of engaging local communities in health care decision making. This study will indicate the appropriate levels at which community preferences are to be elicited and the type of decisions and settings in which they are most relevant.