Increased Consumer Involvement Research Articles

Co‐Production and Health System Reform – From Re‐Imagining To Re‐Making

There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of post‐neoliberal policy concerned with re‐imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co‐production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via ‘choice’ and ‘voice’ participation strategies, the question of how the more challenging approach of co‐production will fare needs to be addressed. The article discusses the possibilities and challenges of system‐wide co‐production for health. It identifies the discourse and practice contours of co‐production, differentiating co‐production from other health consumer‐led approaches. Finally, it identifies issues critically related to the successful implementation of co‐production where additional theorisation and research are required.

Using Systematic Measurement to Target Consumer Activation Strategies

Current policy directions place high expectations on consumers, pressing them to adopt new roles and behaviors. The price of failing to meet these expectations will be high for the individual, for the care delivery system, and for the society as a whole. Yet there is limited support in place to help consumers meet these expectations. The article reviews the major approaches used to stimulate consumer engagement in health and health care. The concept of activation is explored as a possible organizing construct for informing strategies to increase consumer involvement in health. Illustrative data are presented that show how activation levels are associated with engaging in specific health behaviors. The strategy of measuring activation and calibrating both the type and the amount of support for consumers is discussed as a way to improve current approaches. Tailoring activation to the individual, group, and community level is also explored.

Lessons learned from renewable electricity marketing attempts: A case study

The choice of subscribing to renewable electricity has been available to Australian households for more than a decade, yet consumer uptake remains low for some green marketers. This case study uses a retailer's perspective to examine the implementation of a green marketing program for a renewable electricity retailer. Based on interviews, internal company documentation, and secondary research, findings show that effective differentiation for renewable energy is required to increase consumer involvement levels and the likelihood of consideration. While consumers lack understanding of, and interest in, renewable energy, the marketing program relied on customers to seek information. It was apparent the success of green marketing programs depends on the integration of education into a carefully targeted marketing program emphasizing functional and emotional values to differentiate renewable energy and simplify consumer decision-making processes.

Optimizing Environments for Consumer Participation and Self-Direction in Finding Employment

Health and rehabilitation providers are adopting empowering approaches to increase consumer involvement in the service process. This practice trend has evolved in response to the emergence and adoption of consumer-driven models in health care. However, the processes of enabling opportunities for consumers to participate as partners in rehabilitation are difficult and complex. The purpose of this study was to develop a theoretical understanding of the strategies, actions, and interactions between consumers and providers that supported consumer involvement in vocational rehabilitation processes. Data from a grounded theory study involving in-depth interviews with a sample of seven consumers and seven providers were analyzed using the constant comparative approach and Glaser's analysis criteria. A conceptual model of how consumer participation is enacted emerged. Consumer and provider interactions focused on optimizing environments to support consumer partnering and self-direction through establishing shared expectations, advancing consumer potential in practice, and persistently pursuing goals in the community. Opportunities to enhance consumer participation in the social context, practice settings, and the community are elaborated.

‘They just don’t care’: The experiences of mental health consumers in a Queensland bush community

This paper examines the experiences of mental health consumers in a rural community. It is the result of research undertaken in ‘Ruraltown,’ a Queensland rural community, to determine the influence of bush identity on attitudes to mental health. During the course of this research, the negative plight of mental health consumers in the community became apparent. Through questionnaires and interviews with consumers, it was discovered that they felt discriminated against, alienated, disempowered, unsupported and alone. Although consumer input has been acknowledged as essential to mental health reform in recent years, this paper argues that there is still a long way to go. Issues identified by Ruraltown consumers include the negative perception of mental health issues, barriers that they encounter, stigma, and service provision problems. Lack of understanding and support from the community was also raised by consumers as compounding their isolation. The paper concludes with recommendations to enhance the situation for mental health consumers, not only in Ruraltown but in all rural communities. These include increased consumer involvement in mental health awareness, promotion and educational activities, improved service provision and, most importantly, ways to empower and encourage mental health consumers to become valued community members.

Which consumers are ready for consumer-directed health plans?

Consumer Directed Health Plans (CDHPs) are new and increasingly popular insurance products in the United States that aim to increase consumer involvement in health care decision-making. Using quantitative and qualitative methods, we examine characteristics of employees in a large firm that voluntarily enroll in CDHPs. We find salaried and hourly high deductible CDHP enrollees to be substantially healthier and have higher educational attainment than Preferred Provider Organizations (PPO) enrollees. There was less favorable selection into a more popular, lower deductible CDHP.

Mutual, non‐profit or public interest company? An evaluation of options for the ownership and control of water utilities

The purpose of this paper is to evaluate various organizational models for the ownership and control of natural monopolies – specifically the infrastructure of water and sewage provision in England and Wales. First, it summarizes recent discussion of who should own water assets in Britain. The paper notes the opportunity that has arisen for increased consumer involvement, and examines the relative merits of three models that have been suggested as alternatives: a non‐profit trust or company, a public interest company, and a consumer mutual. Five criteria are suggested for evaluating the merits of each type: its ability to safeguard the interests of the most important stakeholder, the consumer; avoid the necessity for a heavy regulatory regime; incentivize management to manage efficiently but without ‘producer capture’; raise capital relatively cheaply; and resist pressures to demutualize. The paper agrees with the recent paper in this Journal by Morse (2000) that, in theory, the consumer mutual has advantages. It draws on Hansmann’s work that suggests consumer ownership of water would be less costly than investor‐ownership, providing there are no large conflicts of interest between different types of consumer. Hansmann’s thesis is expanded to consider the likely benefits from wider member participation, and the hidden costs of not taking members into account. It then tests out whether customers would be motivated in practice to be active members, introducing a theoretical model of what motivates members of co‐operatives and mutuals to participate. The conclusions are that provided managers and board members are committed to encouraging member participation, the consumer mutual model would work well. It would need only light regulation, would avoid producer capture, and would be able to raise capital fairly easily, both from money markets and from members. It would need legislation to prevent it from being demutualized at some time in the future. However, if a participatory corporate culture cannot be guaranteed, or if there is a risk of decline of participation over time, other options such as a non‐profit trust or a public interest company would be less risky.

Consumer Satisfaction

Supported employment has been demonstrated to be a successful rehabilitation model for individuals with severe disabilities. This study was conducted to evaluate the effectiveness of this employment model from the perspective of the individuals with severe disabilities whom it serves. A Consumer Satisfaction Survey, developed by individuals with disabilities and found to be a valid and reliable instrument, was administered to 110 persons with disabilities in Virginia through face-to-face interviews. The results indicated that the majority of consumers like their jobs. Most are happy with supported employment services and would use them again if they lost their job or decided to change jobs. Close to half of the consumers would like to change some aspect of their job to make it better, and more than half feel that their current job is not the career they would like to have permanently. The findings suggest the need to increase consumer involvement in all phases of supported employment service delivery. Strategies to ensure consumer choice and respond to desires to change parts of consumers' jobs or pursue career advancement opportunities are discussed.

Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis.

The authors reviewed the literature to better understand pathways to psychiatric care among young persons experiencing a first episode of psychosis. Because no discrete body of literature exists about how young people with psychotic illness gain access to psychiatric services, the authors examined three related areas: illness recognition, help-seeking, and referral pathways. Automated and manual searches of primarily medical and psychological sources from 1977 to 1995 were conducted. The review found evidence of delay in obtaining early treatment among young people with an emerging psychosis, although comparisons between studies are difficult. Early psychiatric intervention is believed to significantly aid recovery and is an increasingly important clinical issue. Recognizing psychiatric illness is problematic for professionals and nonprofessionals. Understanding of help seeking by patients experiencing a first psychotic episode and of their referral pathways is limited. Taken together, studies suggest factors affecting access to treatment but provide neither sufficient empirical information nor an adequate conceptual framework to better target secondary prevention strategies. Formulation of a pathways-to-care model appears to offer a useful way of understanding mental health care use. Exploration of consumer experiences would enrich the model. Strategies to reduce treatment delay could then be developed and evaluated. Increased consumer involvement might help ensure that services are better tailored to patients' needs.

CATALYSING IMPROVEMENTS IN RURAL HEALTH

ABSTRACT: The National Rural Health Alliance is the peak non‐government body working to improve rural health and health services. It has been fully operational since August 1993 and has produced submissions to government on a number of rural health issues. Through its work it has increased the public profile of rural health policy in Australia, without endangering the autonomy of the 15 national bodies which constitute the Alliance. Given the proliferation of individual bodies concerned with various aspects of rural health, and the complex and changing policy situation, the Alliance has a crucial role to play in helping to manage the interface between governments, consumers and rural health providers. The mission of the Alliance is informed by a strong philosophy of increased consumer involvement in the design, management and evaluation of local health services. The Alliance reflects the aspirations of rural and remote people for high quality and accessible health services. The chances of this mission being accomplished will be increased to the extent that individual professional bodies and local groups work in partnership with central organisations like the Alliance.

The doctor-patient relationship: headed for impasse or improvement?

Deterioration and doctor-patient rapport may be due to increased consumerism, a rise in medical technology, and a societal trend towards deprofessionalization. Increased emphasis on doctor-patient rapport during medical training, closer supervision of studied-patient interactions by physicians trained in the biopsychosocial approach, continuing medical education courses to update the practitioner's interpersonal skills, and a change in medical school admission policies are recommended. Increased consumer involvement in individual doctor-patient relationships and in the health care structure may result in greater patient satisfaction and improved health care.