Legislating Patient Representation: A Comparison Between Austrian and German Regulations on Self-Help Organizations as Patient Representatives

[Representation and representativeness in health councils: between formalization and participatory legitimacy]

The action of social representatives greatly influences the performance of health councils and the quality of participatory management in the Brazilian Unified National Health System. This study aimed to analyze the mechanisms of representation and forms of representativeness within health councils in municipalities of different population sizes. This multiple case study was carried out in Vitória da Conquista, Guanambi, and Urandi, in Bahia State, Brazil. Data and information were obtained by document analysis, observation of plenary meetings, and interviews with 30 health board members. A theoretical matrix structured in five dimensions was used for data analysis: the process to choose representatives; relationships between representatives and those who are represented; types of represented interests; criteria to define positions; and participatory practice. Results showed the predominance of non-electoral criteria to choose representatives. The relationship between representatives and those who are represented shows the former's isolation and reduced accountability. Individual conscience predominated as the board defined positions. The population size of the municipalities also influenced representation in health councils as that with the smallest population evinced consistent weaknesses for the exercise of representation. Results showed insufficiencies in the representative process. This study stresses the need to draw representatives and those they represent near each other and the importance of valuing experiential knowledge as an element that can grant legitimacy to representation.

Self-help friendliness in cancer care: A cross-sectional study among self-help group leaders in Germany

BACKGROUND

Peer support is increasingly recognized as crucial for improving health and psychosocial outcomes in oncological care. The integration of cancer self-help groups (SHGs) into cancer care facilities has gained importance in recent years. Yet, there is a lack of knowledge of the extent and quality of cooperation between cancer care facilities and SHGs and their integration into routine care. The concept of self-help friendliness (SHF) provides a feasible instrument for the measurement of cooperation and integration.

METHODS

A cross-sectional study across Germany investigates the experiences of 266 leaders of cancer SHGs concerning their cooperation with cancer care facilities based on the criteria for SHF. The participatory study was developed and conducted with representatives of the House of Cancer Self-Help and the federal associations of cancer self-help.

RESULTS

According to the SHG leaders, about 80% of their members primarily find their way to an SHG via other patients and only less than 50% more or less frequently via hospitals or rehabilitation clinics. The quality of cooperation with cancer centres, hospitals and rehabilitation clinics, however, is rated as good to very good by more than 70% of the respondents. Nine out of 10 quality criteria for SHF are fully or at least partially implemented, the values vary between 53% and 87%. Overall, 58% of the SHG leaders feel well to be very well integrated into care facilities.

CONCLUSIONS

The results show a positive assessment of the involvement of SHGs in oncological care, but differences between inpatient and outpatient care and low referrals to SHGs are prominent. The concept of SHF is a feasible solution for a systematic and measurable involvement of SHGs.

PATIENT OR PUBLIC CONTRIBUTION

The perspectives and insight of patient representatives obtained through qualitative interviews were directly incorporated into this study. Representatives of cancer self-help organizations were involved in the development of the questionnaire, reviewed it for content and comprehensibility, and further helped to recruit participants.

Representation in participatory health care decision-making: Reflections on an Application-Oriented Model

Context

The involvement of lay people in health care decision‐making processes is now the norm in many countries. However, one important aspect of participation has not received sufficient attention in the past and remains underexplored: representation.

Objective

This paper explores the question of how public participation efforts in collective health care decision‐making processes can attempt to aim for legitimate representation so that those individuals or groups not present can be taken into account in the decisions affecting them. This paper argues that to make decisions that effectively address those affected, representation needs to be seen as a relevant part of any participatory setting. To support this argument, the paper outlines the concepts of participation and representation and transfers them to health care contexts.

Results

A conceptual reflection on responsiveness and the characteristics of representative actors in representative‐participatory settings is introduced, which could provide actors planning to conduct participatory health care projects with tools to reflect on the merits and possible flaws of participatory constellations.

Patient or Public Contribution

The paper contributes to improving public participation in health care decision‐making.

[Mutual self-help and patient participiation: current developments in Austria]

In Austria, health-related self-help groups and organisations have been growing continuously over the past decades. They are increasingly demanding to be accepted as partners of the professional health system and to be involved in health policy decisions.Practice shows that "self-help friendly hospitals" are widespread in Austria. Although some self-help groups/organisations have gained access to health policy committees, research indicates that they find the system unresponsive to their interests. Public support for self-help organisations is particularly lacking at the national level as are conducive conditions for collective patient participation.A recent initiative by the Social Health Insurance Funds, the Ministry of Health and the National Health Promotion Agency seeks to tackle these problems. A plan for public support of self-help groups/organisations, primarily those operating at the national level, has been developed in collaboration with representatives of self-help organisations. It provides financial support for the activities of indication-specific self-help organisations at regional and national levels aiming at strengthening their autonomy. In addition, two institutions were founded: an umbrella organisation of indication-specific self-help organisations and a professional national support agency. The implementation of the new concept offers opportunities for closer cooperation between system stakeholders and self-help groups/organisations, and a new stimulus for patient participation is expected from these two new institutions.

One For All, All For One? Collective Representation in Healthcare Policy

Healthcare collectives, such as patient organizations, advocacy groups, disability organizations, professional associations, industry advocates, social movements, and health consumer organizations have been increasingly involved in healthcare policymaking. Such collectives are based on the idea that individual interests can be aggregated into collective interests by participation, deliberation, and representation. The topic of collectivity in healthcare, more specifically collective representation, has only rarely been addressed in (Western) bioethics. This symposium, entitled: "Collective Representation in Healthcare Policy" of the Journal of Bioethical Inquiry draws attention to this understudied topic from a variety of disciplines, within a variety of socio-cultural contexts. We draw attention to important ethical, cultural, and social questions, and into the practices, justifications for, and implications of collective representation of patients in healthcare policy.