BMJ 1999;318:916-919 ( 3 April )

General Practice

Effect of discussion and deliberation on the public's views of priority setting in health care: focus group study

Paul Dolan, research fellow,  Richard Cookson, research fellow,  Brian Ferguson, senior research fellow. 

Centre for Health Economics, University of York, York YO1 5DD

Correspondence to: Dr P Dolan, Sheffield Health Economics Group, University of Sheffield S1 4DA P.Dolan{at}sheffield.ac.uk

Objective: To investigate the extent to which people change their views about priority setting in health care as a result of discussion and deliberation.
Design: A random sample of patients from two urban general practices was invited to attend two focus group meetings, a fortnight apart.
Setting: North Yorkshire Health Authority.
Subjects: 60 randomly chosen patients meeting in 10 groups of five to seven people.
Main outcome measures: Differences between people's views at the start of the first meeting and at the end of the second meeting, after they have had an opportunity for discussion and deliberation, measured by questionnaires at the start of the first meeting and the end of the second meeting.
Results: Respondents became more reticent about the role that their views should play in determining priorities and more sympathetic to the role that healthcare managers play. About a half of respondents initially wanted to give lower priority to smokers, heavy drinkers, and illegal drug users, but after discussion many no longer wished to discriminate against these people.
Conclusion: The public's views about setting priorities in health care are systematically different when they have been given an opportunity to discuss the issues. If the considered opinions of the general public are required, surveys that do not allow respondents time or opportunity for reflection may be of doubtful value.


Key messages

  • Emphasis is being placed on involving the public in decisions about healthcare priorities

  • Different techniques used to obtain the public's views may give different results

  • People's views on setting priorities differ systematically when they have been given opportunity to discuss the issues

  • People become less willing to discriminate against smokers, heavy drinkers, and illegal drug users when they have had an opportunity to reflect on and discuss their views

  • If considered opinions are required, the value of surveys that do not allow time or opportunity for reflection may be in
    doubt




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