Use Of Deliberative Processes Research Articles

Reinforcing Science and Policy, With Suggestions for Future Research Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide".

Oortwijn et al continue their guide to good practice in the use of deliberative processes in health technology assessment (HTA) based on a survey of international practice. This is useful, and I applaud their care in maintaining objectivity, especially regarding the treatment of moral and politically controversial issues, in reporting how jurisdictions have handled such matters in designing HTA procedures and in their execution. To their suggestions for future research, I add: the historical development of deliberation in healthcare decision-making and in other fields of public choice, with comparisons of methods, successes and failures; development of guidance on the design and use of deliberative processes that enhance decision-making when there is no consensus amongst the decision-makers; ways of identifying and managing context-free and context-sensitive evidence; and a review of high-level capacity building to raise awareness of HTA and the use of knowledge translation and exchange (KTE) and deliberation amongst policy makers, especially in low and middle-income countries.

Deliberative processes in decision making informed by health technology assessment in Latin America.

The objective of Health Technology Assessment International's 6th Latin America Policy Form, held in 2021, was to explore the implementation of deliberative processes in the framework of health technology assessment (HTA) and how agencies in the region could involve stakeholders in this process. This paper is based on a preparatory survey, a background document, and the deliberative work of participants at the virtual Forum conducted in 2021. There were ninety-one participants in the open session and fifty-two in the closed sessions, representing twelve countries and diverse areas of the health sector. While there are mechanisms in most countries in Latin America to consider stakeholder involvement to some degree, it remains reduced or limited to a consultative role, making true participative involvement rare. There are significant barriers and structural and contextual limitations that have impeded or slowed progress toward deliberative processes. Relatively low levels of institutionalization and knowledge about HTA, as well as the lack of trust among stakeholders are important challenges. This situation has impacted health systems by diminishing the legitimacy of decisions and the very structures and processes of HTA. The Forum's broad group of participants identified barriers, facilitators, and recommendations to improve the use of deliberative processes in Latin America to foster improved fairness and reasonableness in HTA and decision making.

Tragic trade‐offs accompany carnivore coexistence in the modern world

AbstractTwo vital policy aims—biodiversity conservation and food production—are increasingly in conflict. Efforts to evaluate trade‐offs between agriculture and conservation have shaped scholarly discourse around two broad strategies to agricultural production that seek to either “share” land with biodiversity or “spare” land from agriculture. However, efforts to negotiate these trade‐offs are challenged by rising concern for the welfare of individual animals, both wild and domestic. We use recent efforts to “coexist” with large carnivores to illustrate how sharing and sparing strategies both create tragic, and often unacknowledged trade‐offs between livestock production and carnivore conservation. We conclude the best means of conserving carnivores while feeding the world's growing population requires explicitly confronting and adjudicating ethical trade‐offs associated with sharing and sparing approaches. To accomplish this, we recommend engaging scholars trained in ethics and social justice and use of deliberative processes to synthesize disparate facts and competing values when evaluating trade‐offs.

Identifying the Need for Good Practices in Health Technology Assessment: Summary of the ISPOR HTA Council Working Group Report on Good Practices in HTA

The systematic use of evidence to inform healthcare decisions, particularly health technology assessment (HTA), has gained increased recognition. HTA has become a standard policy tool for informing decision makers who must manage the entry and use of pharmaceuticals, medical devices, and other technologies (including complex interventions) within health systems, for example, through reimbursement and pricing. Despite increasing attention to HTA activities, there has been no attempt to comprehensively synthesize good practices or emerging good practices to support population-based decision-making in recent years. After the identification of some good practices through the release of the ISPOR Guidelines Index in 2013, the ISPOR HTA Council identified a need to more thoroughly review existing guidance. The purpose of this effort was to create a basis for capacity building, education, and improved consistency in approaches to HTA-informed decision-making. Our findings suggest that although many good practices have been developed in areas of assessment and some other key aspects of defining HTA processes, there are also many areas where good practices are lacking. This includes good practices in defining the organizational aspects of HTA, the use of deliberative processes, and measuring the impact of HTA. The extent to which these good practices are used and applied by HTA bodies is beyond the scope of this report, but may be of interest to future researchers.

A Health Economics Approach to US Value Assessment Frameworks—Summary and Recommendations of the ISPOR Special Task Force Report [7

This summary section first lists key points from each of the six sections of the report, followed by six key recommendations. The Special Task Force chose to take a health economics approach to the question of whether a health plan should cover and reimburse a specific technology, beginning with the view that the conventional cost-per-quality-adjusted life-year metric has both strengths as a starting point and recognized limitations. This report calls for the development of a more comprehensive economic evaluation that could include novel elements of value (e.g., insurance value and equity) as part of either an “augmented” cost-effectiveness analysis or a multicriteria decision analysis. Given an aggregation of elements to a measure of value, consistent use of a cost-effectiveness threshold can help ensure the maximization of health gain and well-being for a given budget. These decisions can benefit from the use of deliberative processes. The six recommendations are to: 1) be explicit about decision context and perspective in value assessment frameworks; 2) base health plan coverage and reimbursement decisions on an evaluation of the incremental costs and benefits of health care technologies as is provided by cost-effectiveness analysis; 3) develop value thresholds to serve as one important input to help guide coverage and reimbursement decisions; 4) manage budget constraints and affordability on the basis of cost-effectiveness principles; 5) test and consider using structured deliberative processes for health plan coverage and reimbursement decisions; and 6) explore and test novel elements of benefit to improve value measures that reflect the perspectives of both plan members and patients.

Politicization and publicization: the fragile effects of deliberation in working-class districts

A deep understanding of the use of deliberative processes requires a political ethnography able to detect their consequences for the participants and for the public sphere. This article analyses a participatory process organised in France by an activist-professional facilitator with a small group of bureaucrats and marginalized individuals, designed to promote mutual understanding and raise public issues. This ethnography shows that deliberation in small groups, rather than merely producing consensus and reproducing inequalities in accessing forms of public expression as is sometimes alleged, may generate at least preliminary politicization and the publicization of social issues in working-class districts. These rather fragile effects raise the question of the continuity of collective action and institutional transformations generated by deliberative processes.

NICE's use of cost effectiveness as an exemplar of a deliberative process

This paper seeks to test 12 conjectures about the predicted use of deliberative processes by applying them to the technology assessment procedures used by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. A deliberative process is one that elicits and combines evidence of different kinds and from different sources in order to develop guidance - in the present case, guidance for a health care system. A deliberative process entails the integration of three kinds of evidence: scientific context-free evidence about the general clinical potential of a technology, scientific context-sensitive evidence about particular evidence in realistic scenarios, and colloquial evidence to fit context-free scientific evidence into a context and to supply the best evidence short of scientific evidence to fill in any relevant gaps. It is shown that NICE's appraisals procedures and, in particular, its approach to cost effectiveness, entail both the weighing of each of these types of evidence and can be seen as rational responses to the 12 conjectures.

Evaluating the Effectiveness of Deliberative Processes: Waste Management Case-studies

Public participation in decision making through the use of deliberative processes is now widely promoted as the means of enhancing institutional legitimacy, citizen influence and social responsibility and learning. Different methods are being tried but key questions remain about what works best and how practice could be improved. This paper discusses four examples of the application of community advisory committees and citizens' juries to waste strategy development by English local authorities. It evaluates the processes using criteria based on the concept of the fair and competent process, and identifies lessons for the optimum process.

Evaluating the Effectiveness of Deliberative Processes: Waste Management Case-studies

Public participation in decision making through the use of deliberative processes is now widely promoted as the means of enhancing institutional legitimacy, citizen influence and social responsibility and learning. Different methods are being tried but key questions remain about what works best and how practice could be improved. This paper discusses four examples of the application of community advisory committees and citizens' juries to waste strategy development by English local authorities. It evaluates the processes using criteria based on the concept of the fair and competent process, and identifies lessons for the optimum process.