Founded in 1994, the Center for Health Decisions was a non-partisan, non-profit organization that merged with CHPR in 2017.
The Center for Health Decisions’ (CHD) mission was to advance health and healthcare that reflects the values of an informed public.
While active, staff members collaborated with UC Davis researchers and others to promote civic engagement and capture public views on contemporary, controversial, and value-laden health issues. Target audiences for study findings included local, state, and national policymakers, community members, and other stakeholders, such as purchasers and practitioners. Active projects concluded in 2022.
CHD and CHPR worked together to:
Since its creation in 1994, the Center for Health Decisions:
CHD received funding from philanthropic grants, contracts with other organizations, donations, honoraria and in-kind contributions.
Grants and contributions
CHD staff served in roles on committees and boards with a wide range of organizations.
As public input has gained credibility as a relevant contribution to healthcare reform, healthcare leaders have shown interest in developing and instituting deliberative processes with their constituents. CHPR worked with the Center for Health Decisions (CHD) to provide non-partisan work with the public and brought insights into individual and societal values that are particularly relevant to healthcare reform.
With so few non-profit, non-partisan organizations focusing on the “citizen” perspective, CHD’s knowledge benefited state and national groups working to improve healthcare quality, coverage and affordability. Consequently, CHD staff was often recruited as members of boards and advisory committees. Staff worked with policymakers, healthcare providers, government agencies, professional associations, community organizations and researchers to understand the views and priorities of the public.
CHAT® (Choosing All Together) is a computerized process for individual and group decisions. Licensed through the University of Michigan, CHAT is an effective tool for establishing coverage priorities and for other types of priority-setting when multiple options are available. Starting in 2002, CHD designed more than a dozen versions of CHAT for use in California and other states, facilitating more than 300 sessions with various demographic populations.
CHAT® is a simulation exercise, allowing participants to use their own experiences, beliefs and values to create the best possible coverage for themselves and others.
CHAT was created by bioethicists at the University of Michigan and the National Institutes of Health who understood that the public needed more information and opportunities to participate in policy discussions that impact them and their communities. CHD customized the CHAT process and utilized it with four unique projects in California. CHD also worked with four other states to help them design their own CHAT board and engage their state residents in this social decision-making exercise. CHAT comprises both a qualitative and quantitative process. The goal is to better understand what participants most value and why. Data from all sessions are collected and analyzed, along with answers to pre- and post-session survey questions.
Responding to growing interest in universal health care (pre-ACA), more than 900 insured and uninsured Californians defined the core components of an essential health plan. Project results showed:
In response to anticipated cuts in the state’s Medi-Cal budget, adults with disabilities identified the most acceptable trade-offs if funding was to be reduced by 15%. The California Foundation for Independent Living Centers recruited 131 non-institutionalized adults with disabilities to participate in 12 discussion groups statewide. Results were shared with leaders at the CA Department of Health Care Services. Publications include:
Facing increased coverage costs, employers sought guidance in addressing the tensions between what consumers want and what companies are able to purchase. We worked with seventy-one public and private sector companies in the Sacramento region and learned the coverage priorities of their 750 employees.
Many of the challenging issues affecting healthcare policy or practice relate to healthcare quality, cost containment, physician or patient authority, and the results and use of medical research. Both the lay public and healthcare professionals can best respond to complex trade-offs when those trade-offs are described to them using scenarios that illustrate the issue through a common medical situation. Case scenarios are used as examples of the issue at stake; from these examples – and by introducing variations in the scenarios – facilitators draw out the underlying principles that are foundational for individual/group choices.
During its planning phase, Covered California (the state’s health benefit exchange) asked CHD to find out how future beneficiaries would structure healthplan cost-sharing in the fairest way possible to meet the needs of new enrollees. CHD held deliberative sessions with ten discussion groups throughout the state, meeting with a total of 113 uninsured Californians. Participants reviewed and prioritized multiple case studies that illustrated how different cost-sharing models would affect patients with different needs: chronic illness, episodic care, catastrophic care and preventive care.
What Matters Most tackled a key aspect of healthcare reform efforts: at a time of rising healthcare costs, what medical situations are most essential for coverage and which are less essential? The project included a telephone survey of 1019 randomly sampled Californians. Each ranked 10 (of 80) short medical vignettes on a scale of coverage importance. This was followed by 15 group discussions with 176 community members who reviewed the results of the phone survey and provided their reasoning for differentiating higher and lower priorities. Findings were reported in the Congressional Quarterly, on Talk of the Nation and through other national media outlets.
In June 2012, CHD completed a pilot project, Probing the public's views on V-BID, with partners in Michigan that was designed to determine how average employees consider the pros and cons of using value-based insurance design as a tool for encouraging high-value healthcare and discouraging low-value healthcare.
In an effort to help leaders of the California Hospital Assessment and Reporting Taskforce (CHART) evaluate how useful consumers find its work, CHD asked diverse groups of consumers throughout California to consider four quality domains: clinical effectiveness, patient safety, responsiveness to patients, and efficiency. Using an Audience Response System (keypad voting) and a series of case scenarios, project participants were asked to prioritize the relative importance of these domains and discuss the rationale for their decisions. The CHD report was distributed nationally to organizations sponsoring hospital public-reporting websites.
Phone or internet surveys are not considered deliberative, but CHD occasionally used surveys to lay a foundation for a deliberative process. For example, identifying the public response to an uncomplicated healthcare policy issue through use of a survey could form the basis for a more detailed deliberative exploration that involves trade-offs. In other instances, a survey can be used to validate qualitative conclusions drawn using other approaches.
What Matters Most tackled a key aspect of healthcare reform efforts: at a time of rising healthcare costs, what medical situations are most essential for coverage and which are less essential? The project included a telephone survey of 1,019 randomly sampled Californians. Each ranked 10 (of 80) short medical vignettes on a scale of coverage importance. 15 group discussions were then conducted with 176 community members who reviewed the results of the phone survey and provided their reasoning for differentiating higher and lower priorities. Findings were reported in Congressional Quarterly, Talk of the Nation and other national media outlets.
This regional project was a community-wide dialogue on the role that cost plays in healthcare treatments and coverage decisions. Designed to gauge the public’s notion of cost-effectiveness as a component of medically necessary care, this was an extension of Stanford University’s earlier report on Defining Medical Necessity. Consumers weighed in on one of society's most difficult dilemmas: how to balance the medical needs of individuals with those of the larger community. CHD conducted a written survey of 500+ physicians, held 25 discussion groups with 263 consumers and commissioned a 500-person randomly sampled phone survey of the general public. Results were presented in CA and nationally. To see an example of how average consumers debate a controversial health policy issue, view this video.
While our work was primarily meant to inform healthcare policy and practice, deliberative discussions were also educational for participants. Regardless of the healthcare topic, the process itself exposes individuals to insights about themselves and others and fosters understanding of “social decision-making” – when the needs of many people are taken into account. This is especially important in healthcare, for which the structure of the system, financing and care delivery are based on models that must serve diverse populations.
Lectures about health insurance are exceedingly complicated and inherently boring. But when you ask groups of people to negotiate and collaborate on policy decisions, this activity improves their understanding of healthcare and appreciation for the collective wisdom that emerges and that is not boring. In fact, it is stimulating in ways that surprise people and helps to connect them to real world situations.
CHD started using CHAT for interactive group discussions in 2002. While most of this work was project-specific – to help address healthcare policy dilemmas about what health plans should cover – we learned quickly that this process does more than answer research questions. It helps individuals think about healthcare policy from a different perspective – the perspective of citizens grappling with competing priorities and disparate values.
For that reason, we used CHAT for three distinct purposes:
Community members who typically do not participate in local police reform discussions acted as community representatives for this public deliberation process about police reforms.
Working with the Statewide Workgroup on Reducing Overuse, this project involved 117 Medi-Cal, Covered California, and CalPERS members in discussions on strategies for reducing overuse.
This report summarizes pilot project findings on the views of the public regarding various actions to reduce the overuse of ineffective or unnecessary medical interventions.
810 current and future Medicare beneficiaries, healthcare professionals and community leaders in California offered their insights which comprise this report on how Medicare can best meet the needs of future generations. A 4-page Executive Summary is also available.
As a sub-contractor to AIR, CHCD worked on this national 3-year AHRQ-funded grant to learn how the general public responds to the use of evidence in healthcare decision-making.
For this project, uninsured Californians considered the fairest way to structure health plan cost-sharing when trying to meet the needs of many Californians.
In this report, employees discuss V-BID options for encouraging high-value healthcare and discouraging low-value care.
Californians prioritized four IOM hospital quality domains during this project to help guide corrective actions by California hospitals.
In this project, 1200 Californians identified the medical situations they felt were most essential for healthcare coverage and those that are not.
Developing health coverage with a limited budget, uninsured Californians conveyed their coverage priorities and trade-offs.
Northern Californians constructed a lower-cost health plan for the uninsured by identifying key aspects of minimum coverage for this study.
For this project, consumers debated when it is appropriate to deny coverage if the expense of treatment greatly exceeds the benefit.
Medi-Cal beneficiaries conveyed their views and priorities about Medi-Cal coverage in the face of budget cuts for this study.
Public and private sector employees weighed in on their healthcare coverage -- and found ways to compromise.
In this study, physicians and consumers had different views on medical treatment that offers small benefits at high costs.
Sacramento Area consumers and health professionals collaborated in this study on how to improve care at the end of life.
CHD was often invited to state and national meetings and conferences to present and discuss its work related to healthcare reform or improving end-of-life care. Select presentations on issues related to healthcare reform:
Select presentations on end-of-life care: