Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Postal address: Box 564, Uppsala, 751 22, Sweden.
BMC Health Serv Res. 2023 Sep 4;23(1):947. doi: 10.1186/s12913-023-09947-x.
In systems with representative democracy, there is a growing consensus that citizens should have the possibility to participate in decisions that affect them, extending beyond just voting in national or local/regional elections. However, significant uncertainty remains regarding the role of public involvement in decision-making, not least in healthcare. In this article, we focus on citizen dialogues (CDs) in a health system that is politically governed and decentralised. The aim of the study was to evaluate the functioning of citizen dialogues in the Swedish health system in terms of representation, process, content, and outcomes.
This study was conducted using a qualitative case design focusing on CDs at the regional level in Sweden. The regional level is politically elected and responsible for funding and provision of healthcare. The data consist of public documents describing and evaluating the CDs and interviews, which were analysed drawing on a modified version of the Abelson et al. analytical framework for evaluating public involvement in healthcare.
Some CDs were an attempt to counteract political inequality by inviting groups that are less represented, while others aimed to increase legitimacy by reducing the distance between policymakers and citizens. The results from the CDs-which were often held in the beginning of a potential policy process-were often stated to be used as input in decision-making, but how was not made clear. Generally, the CDs formed an opportunity for members of the public to express preferences (on a broad topic) rather than developing preferences, with a risk of suggestions being too unspecific to be useful in decision-making. The more disinterested public perspective, in comparison with patients, reinforced the risk of triviality. A need for better follow-up on the impact of the CDs on actual decision-making was mentioned as a necessary step for progress.
It is unclear how input from CDs is used in policymaking in the politically governed regions responsible for healthcare in Sweden. The analysis points to policy input from CDs being too general and a lack of documentation of how it is used. We need to know more about how much weight input from CDs carry in relation to other types of information that politicians use, and in relation to other types of patient and public involvement.
在实行代议制民主的制度中，人们越来越认为公民应该有可能参与影响他们的决策，而不仅仅是参与国家或地方/地区选举投票。然而，在医疗保健领域，公众参与决策的作用仍存在很大的不确定性。在本文中，我们关注的是在政治治理和权力下放的卫生系统中开展的公民对话。本研究的目的是评估瑞典卫生系统中的公民对话在代表性、过程、内容和结果方面的运作情况。
本研究采用定性案例设计，重点关注瑞典地区一级的公民对话。地区一级是政治选举产生的，负责为医疗保健提供资金和服务。数据包括描述和评估公民对话的公开文件以及访谈，我们根据 Abelson 等人评估医疗保健中公众参与的分析框架的一个修改版本对其进行了分析。
一些公民对话旨在通过邀请代表性不足的群体来对抗政治不平等，而另一些则旨在通过缩小决策者和公民之间的距离来提高合法性。这些公民对话的结果（通常是在潜在政策过程的开始阶段提出的）通常被表示为用作决策的投入，但如何使用并不明确。一般来说，公民对话为公众提供了表达偏好（在广泛的主题上）的机会，而不是发展偏好，这存在建议过于不具体而无法在决策中使用的风险。与患者相比，公众更不感兴趣的观点加剧了琐碎化的风险。有人提到，需要更好地跟踪公民对话对实际决策的影响，这是取得进展的必要步骤。
目前尚不清楚瑞典负责医疗保健的政治治理地区如何在决策中使用公民对话提供的意见。分析表明，公民对话提供的政策意见过于笼统，并且缺乏有关如何使用这些意见的文件记录。我们需要更多地了解公民对话提供的意见在多大程度上与政治家使用的其他类型的信息以及与其他类型的患者和公众参与相关。
