Citizens Conference

Health Care Priority Setting: Who shall decide and how?

In September 2013, we organized the citizen’s conference “Health Care Priority Setting: Who shall decide and how?”. Within the conference, twenty citizens of Mainz discussed at two weekends requirements and criteria for fair decision-making procedures in health care priority setting.  

As a kind of open and deliberative procedure, the conferences’ purpose was to assemble a group of citizens and give them an opportunity to form an (joint) opinion in close interaction with their fellow citizens, which afterwards can enrich the political debate.

Content of Discussion

The central question to be discussed was, which decision-making bodies and procedures are seen as fairly and properly by the citizens and how they would design a decision-making procedure for the definition of the health benefit basket in Germany.  

In Germany, decision-making procedures for the definition of health benefit baskets are already in place, but are rarely known by the public. Even persons with an explicit affiliation to the health care system such as doctors or nurses often do not know who decides on the reimbursement of drugs or medical services. Considering the importance of these decision, we think that we need an open and public debate on these decision-making procedures.

Goals of the conference

Our prior goal was the investigation of the citizens’ preferences on how to design a decision-making procedure: What demands are made by the citizens and what are in their view basic requirements for a just decision-making procedure? Which criteria do they apply or prefer to assess decision-making procedures and decision-making outcomes? A finally, how would they design a concrete decision-making procedure, that means, which institutional characteristics would they choose in order to establish a just decision-making procedure for the allocation of health care services, and why?

Based on the consideration that nearly everybody has yet faced questions in his or her life of how to make good collective decisions and thus has an idea of just and constructive decision-making, we think that this ordinary experiential knowledge can contribute to a public debate on just decision-making procedures.

Considering the increased significance of deliberative and participative democracy and the need for new participatory instruments we also hoped that we gain some insights on the potential of a method which is until now rather rarely used in Germany. What can be achieved within a citizens’ conference, how do it influence participants, and last but not least, how is it received by politicians and the broader public?

Task for the Citizens

The participants were requested to develop concrete proposals for the establishment and design of a decision-making procedure which determines the health benefit basket in Germany. At the end of the conference they should adopt a joint document, the “Citizens Vote”, which displays their major ideas and central “findings”. In their discussion, the citizens were supported by an extern moderator, Joachim Fahrwald.

Course of the Conference

The conference started at 09/13/2013 with an opening ceremony at the University of Mainz. After welcome speeches held by the Lord Mayor of Mainz, Michael Ebling, and the Vice President of the Gutenberg-University Mainz, Prof. Dr. Mechthild Dreyer, three scientific experts (Katharina Kieslich, Sabine Stumpf and Katharina Böhm) gave a first introduction to the topic, followed by a Q&A session. Afterwards, all attendees had opportunity to get to know each other.

The conference sessions were held at 09/14/ - 09/15/2013 and 09/28/ - 09/29/2013 at the Favorite Parkhotel in Mainz.

The Citizens Vote was presented at 10/02/2013 in the Council Hall of Mainz to a broader public, subsequently it was also sent to several representatives and decision-makers.

Budget and Financing

The conference was sponsored with 50 000 EUR by the VolkswagenStiftung, which is one of the biggest foundations in Europa and the biggest private science sponsor in Germany.

The VolkswagenStiftung is not a company-related foundation, but an independent, private non-profit foundation. Its grants are generated through a capital stock of currently circa 2,6 billion Euro.

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