Deliberative Processes in Decisions About Health Care Technologies: Combining Different Types of Evidence, Values, Algorithms and People
OHE Briefing, No. 48, June 2009
20 Pages Posted: 27 Aug 2015
Date Written: June 1, 2009
In the UK and elsewhere, choices about how to allocate limited health care resources are guided not only by cost-per-QALY calculations, but also by social value judgements such as those relating to equity and fairness. Factors such as uncertainty around key values, operational feasibility and stakeholder interests also need to be considered. The question of how one ought to combine these various inputs is central to the field of health care decision making.
There is a continuum of approaches to answering this question. At one end sits the algorithm and formulaic methods of combining information, albeit with some attribution of a score usually required. At the other end sits a ‘pure’ deliberative process. In between there are a variety of ‘structured’ deliberative processes that may combine facilitation of some form with the use of decision weights generated both by the deliberative process and from outside.
This briefing follows the OHE lunchtime seminar held in September 2008, in which Professor Tony Culyer presented a series of conjectures about the circumstances under which deliberative processes are likely to be useful, and the characteristics that deliberative processes ought to possess in order for their successful application to health care decision making. A lively discussion was then introduced by Professor Jack Dowie, who put forward the view that the best collective decisions may be the product not of consensus and compromise, but of disagreement and contest. Jack also argued for the use of one form of Multi-Criteria Decision Analysis which used web based software as a means of eliciting and aggregating inputs in an impersonal and efficient manner. A short comment by Jack, which mirrors his contribution to the seminar and provides the basis for much of Tony’s discussion of algorithms, group polarisation and ‘value of analysis analysis’, is available online at ohe dot org.
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