Health System Reform: Bringing Public Values into Health Care Policy

1. Health System Reform: Bringing Public Values into Health Care Policy Tony Culyer Ontario Research Chair in Health Policy & System Design

2. Some hard-nosed questions • Is it safe? • Does it work? • For whom does it work? • Relative to what does it work better or worse? • At what cost does it work? • Is the expected health gain (if there is one) worth the extra cost? • What’s the evidence with bearing on these questions?

3. Evidence-based and evidence-informed policy Evidence never speaks for itself: it needs to be • contextualised (does it apply here?) • evaluated (is it reliable? Is it complete? Is it contested?) • integrated with other knowledge(are decision makers equipped to do this – in the field manageability, financials?) and • suffused with values (do the outcome measures adequately represent patient health gain, will their use affect the fairness of the health care system?)

4. The all-pervasive social values • What components ought to go into a measure of health or health gain – and with what weights? • Should an additional year of healthy life count for the same for everyone (people in their last year of life? Children? The relatively healthy?) • If it turns out to be more costly to deliver care to some subgroups than others, could that justify denying the more costly care to its potential beneficiaries? • Should we support measures (such as anti-smoking campaigns) that widen health disparities in the community?

5. Answering questions like these and integrating them requires: • consultation • participation and • deliberation

6. Today: In this session we shall get a view of the importance of evidence-informed decision-making from • a MOHLTC colleague, Alison Paprica, and hear from • the chair of the Citizens’ Council, Gerri Gershon about Ontario’s brave experiment in obtaining people’s values through direct democracy in health care policy