Croakey is hosting a discussion about the new primary health care organisations to be known as Medicare Locals. We’re crowdsourcing ideas about how to effectively engage consumers in setting their priorities and directions.
In a previous post, Carol Bennett from the Consumers Health Forum cautioned against tokenistic approaches to consumer engagement.
In the article below, health policy analyst Jennifer Doggett says there is good evidence that consumer engagement can make a difference to health policies and programs, but that we need more research to establish the best mechanisms for it.
Jennifer Doggett writes:
I agree with Consumers’ Health Forum executive director Carol Bennett that consumer involvement in Medicare Locals (MLs) is not just about tokenism or political correctness. Consumer involvement is about making MLs work better – that is more efficiently and effectively – to meet community needs. This aim is based on research which shows that consumer involvement improves the delivery of health programs and services.
In a report I prepared for the Consumers’ Health Forum earlier this year I looked at the impact of consumer representatives on medical decisions and outcomes.
Based on a literature review and case studies with Australian consumer representatives, I found good evidence that consumer representatives had influenced the delivery of health policies and programs in a number of ways.
These included: identifying consumer issues relevant to a medical/health program or service; improving the design and targeting of health communication strategies; influencing the content of medical education and training programs; influencing reporting requirements; influencing the content of health policies; contributing to a cultural shift to broader views on consumer participation in health policy and program development; changing the rhetoric and terminology of health policies and communications to reflect consumer experience; and achieving improvements in transparency of committee decision making processes.
To give one example of research in this area, a Swedish study evaluated a program where patient and health-care providers participated together in the local planning of diabetes care in Sweden. The impact of this program was tested in 17 primary health-care centres and the research focussed on the problems identified by staff and consumers, plans for their solution, and the results after 18 months. The study concluded that many problems, mainly dealing with the organization of diabetes care and a number of possible solutions to them, were identified, and after 18 months a majority (70%) of the solutions had been implemented.
If MLs are to deliver maximum outcomes to the Australian community, the involvement of consumers is vital. It is also important that this involvement occurs in a way which maximises its benefits. Like all health care resources, consumer representatives are scarce, valuable and need to be used to their greatest potential.
Unfortunately, there is not a wide research base to inform the ways in which consumer involvement in the health sector occurs. There are very few studies which assess the cost and benefits of consumer input into the development of health policies and programs (although those that do conclude that it delivers good value). There are also very few studies which compare different mechanisms for involving consumers in making decisions about health and medical services.
The strongest finding in this area, supported by reported experiences of Australian consumer representatives, is that the training, networking and support provided by a body like CHF is essential. The consumer representatives I interviewed for the CHF report, discussed above, all mentioned the key role of CHF in ensuring that they were able to provide effective input into their respective committees and use their experiences to inform consumer participation in health care more broadly.
Given these findings, the $2.9 million dollars allocated by the Government to establish a national network of trained and accredited health consumer representatives should be welcomed. Some modest additional funding to research the impact of this involvement on the outcomes delivered by MLs would strengthen the research base for consumer input into health care decision making and provide useful data for health policy makers and mangers in the future.
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Previous posts in this discussion:
Helen Keleher
http://blogs.crikey.com.au/croakey/2010/10/12/a-call-for-healthy-action-beyond-medicare-locals/
Mark Harris
http://blogs.crikey.com.au/croakey/2010/10/13/plenty-of-challenges-ahead-for-medicare-locals/
Michael Moore
http://blogs.crikey.com.au/croakey/2010/10/13/and-some-more-questions-about-medicare-locals/
