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Among the many controversial innovations of Oregon's basic health services reform, perhaps the most favorably received was the state's effort to involve citizens in the prioritization process.Through public hearings, community meetings, and an opinion survey, the legislature and the Health Services Commission (HSC) sought to elicit directly from Oregonians the "public values" on which the ranking of health treatments would in part depend.Observers hailed the effort as "an open, public moral debate," 1 "an experiment with health-care-by-democracy," 2 and "a classic exercise of American democracy." 3Despite these glowing notices, defects in design undercut Oregon's participatory process, and it fell short of achieving all the benefits for which its initiators hoped.This paper offers a sympathetic critique of Oregon's pioneering experiment in order to help improve future programs that similarly try to involve citizens in making vital decisions.An orientation to the future is especially appropriate because the Oregon participatory planning process could be the first of many comparable efforts in bioethics and health policy.The Oregon Basic Health Care Act requires the HSC to update its priority listing of health services every two years, and the statutory mandate of public hearings and community meetings appears to apply to future HSC reports, notjust the initial list approved by the legislature in 1991. 4 Oregon Health Decisions (OHD), the group that organized community meetings for the HSC, is the prototype for a nationwide Community Health Decisions (CHD) movement, which seeks to bring "a cross-section of the citizenry together with health care professionals, state and local officials, consumer t
Jack H. Nagel (Fri,) studied this question.