Involving Consumers in Health Care Decision Making

HEALTHCAREANALYSIS VOL.3:196-204 (1995)

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Phil Shackleyand Mandy Ryan
Health Economics Research Unit, University of Aberdeen, Scotland Abstract

This paper considers ways of involving consumers in decisions regarding the allocation of scarce health service resources. Specifically, two levels of consumer participation are highlighted and discussed. These are: (1) at the level of deciding whether or not a particular service should be introduced or its scale changed; and (2) at the level of deciding how best to provide a service once it has been decided that the service will be provided. The limitations of the current methods of involving consumers are outlined and two alternative approaches discussed. These are willingness to pay and conjoint analysis.

Introduction
Limited resources coupled with unlimited d e m a n d for health care mean that decisions have to be m a d e regarding the allocation of scarce resources across competing health care interventions. Traditionally, the extent of consumer (patient) involvement in this decision making process has been minimal. However, with the advent of the recent reforms of the UK National Health Service (NHS), greater consumer involvement has been advocated. 1-3 A policy emphasis on increasing patient choice and the implication that this is a good thing indicates that the UK government envisages consumers in the 'new ' NHS as having a m u c h more active role in health care decision making. Although the background to this paper is the recent reforms of the UK National Health Service, the concepts discussed are relevant to any health care system in which community values a n d / o r patient preferences are elicited. In this p a p e r w e consider ways of involving consumers in decisions regarding the use of

scarce health care resources. Consumer involvement is considered at two distinct levels. The first concerns decisions about w h e t h e r or not a particular service should be introduced or its scale changed

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