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Biomedical subjects

V Wiseman

Publications and source records attributed to V Wiseman.

9 recordsLinked to original sources
PubMed2003

Involving the general public in priority setting: experiences from Australia.

The discussion over whether community preferences have a legitimate role to play in priority setting has been highly polarised. Skeptics warn of the risk of establishing a 'dictatorship of the uninformed', while advocates proclaim the legitimacy of the participatory process. The one group who appears not to be consulted in this debate is the citizens themselves. In this study, a convenience sample of 373 citizens attending two medical clinics in central Sydney were surveyed about whether the general public has a legitimate role to play in informing priority setting in health care. Respondents were presented with three different levels of priority setting: across health care programmes, across medical procedures, and at a global level. To assist respondents in understanding the choices and trade-offs involved, they were given information about current levels of funding and the cost-effectiveness of each alternative. Respondents were asked whether they felt the preferences of the general public should be used to inform priority setting at each level. Of particular interest was the question of whether their willingness to use public preferences depended on the level of priority setting. Respondents were also asked about who else's preferences should be used to inform priority setting at each level. The results suggest that the public overwhelmingly want their preferences to inform priority-setting decisions in health care. This was seen to be particularly important in informing decisions about how to prioritise across broad health care programmes and about the criteria to be used to allocate funds across different population groups. In contrast, the preferences of medical professionals and health service managers were rated most highly in relation to the prioritisation of different treatments and medical procedures. In most cases, however, respondents did not advocate the use of one particular group's preferences. Even when the preferences of the general public were considered most important, it was felt that any decision-making process needed to be informed by the preferences of a range of groups. The preferences of politicians were viewed as least important to processes of priority setting in health care.

Adolescent↗
PubMed2000

Resource allocation within Australian indigenous communities: a program for implementing vertical equity.

Given the significant disparities in health and health related disadvantage between Aboriginal and non-Aboriginal Australians, the application of some notion of equity has a role to play in the formulation of policy with respect to Aboriginal health. Aboriginal and Torres Strait Islander has been abbreviated to Aboriginal. There has been considerable debate in Australia as to what the principles of equity should be. This paper discusses the relevance of the principle of vertical equity (the unequal, but equitable, treatment of unequals) to Aboriginal health funding. In particular, the paper advocates pursuing procedural justice as the basis for vertical equity where the focus is on the fairness of how things are done rather than on the distribution of outcomes per se (i.e. distributive justice). Particular attention is paid to how the principle of vertical equity might be handled at a practical level. Details of the approach used in a number of Australian indigenous communities are discussed. It is concluded that there are strong arguments for pursuing procedural justice under vertical equity particularly when there are cultural differences in the way health is defined and when there is importance attached to indigenous involvement in the health care decision making process.

Adolescent↗
PubMed1998

From selfish individualism to citizenship: avoiding health economics' reputed 'dead end'.

Recent interpretations of citizenship are firmly rooted in the value of social membership and social participation. Citizens are described as having a moral right to draw upon the support of the community, but at the same time have a responsibility to contribute to the provision of social services such as health care. In contrast, contemporary health economics has been criticised for taking a narrow and individualistic view of human behaviour. This paper examines the extent to which economic theory and practice have been developed to accommodate a more 'civic' view, namely, the notions of mutual concern for community members, social participation and social rights. It is argued that because the provision of health care is often linked to feelings of compassion and social responsibility and not just to individual well-being, this sort of insight may enrich economic analysis and, in turn, provide a way around health economics' reputed 'dead end'.

Altruism↗
PubMed1998

Burden of illness estimates for priority setting: a debate revisited.

This paper returns to the debate in this journal about a decade ago on the value of cost of illness (COI) and burden of illness (BOI) estimates in priority setting. Concern is expressed that there has been a resurgence of interest in calculating and using BOI estimates in such priority setting. It is especially concerning that this interest seems to have support from both the World Bank and the World Health Organisation (WHO) (although perhaps less so recently from the latter). It is argued that in terms of priorities for health services, BOI calculations are irrelevant except possibly in the context of some (less than ideal) concept of need in support of equity. If the need basis for equity is set in terms of 'capacity to benefit', then BOI calculations become even less relevant. There is an argument for some research funding being prioritised in terms of BOI but only when it is genuinely the case that there is total ignorance, beyond the size of the problem, about a particular policy or disease area. Such a level of ignorance will happen very seldom and then some fairly approximate estimates of BOI will suffice. It is better to concentrate in priority setting on estimating the costs and benefits of marginal changes than devoting scarce analytical resources to superfluous estimates of BOI.

Australia↗
PubMed1997

Caring: the neglected health outcome? or input?

In most forms of evaluation of health care--and it is certainly true of economic evaluation--and is considering the outcomes of such care, caring tends to be omitted, or simply forgotten. It is often the case that little more than lip service is paid to the inclusion of caring as an input. This paper takes a closer look at caring, the neglected outcome of health care. The perspective starts from that of economics but other disciplines are examined briefly along the way to determine whether they deal better with caring than does the dismal science of economics. It is concluded that there is a need for greater consideration of caring as both an outcome and an input in evaluation of health care and that in the specific context of economic evaluation, when considering caring, economists might usefully look to other disciplines to broaden and deepen their conceptualisation of both benefits and costs in their economic evaluation studies.

Australia↗
PubMed1995

Examining preferences for allocating health care gains.

This study is part of a programme to elicit and examine community preferences for health care in different contexts. Data were obtained from a group of predominantly Australian health care decision-makers. A short questionnaire contained six valuation questions and four demographic questions. The six valuation questions posed choices where equal health gains were to be allocated to different population groups based upon: age; sex; current health; socio-economic status; across time; and across different numbers of individuals. The results provide some evidence that respondents were prepared to discriminate between health gains derived in different contexts especially where health gains were to be allocated between groups of different health status and over time. Further research is planned and the possible implications for health policy, and in particular for resource allocation in health care, are briefly discussed.

Age Factors↗