The rationale and design of public involvement in health-funding decision making: Focus groups with the Canadian public

Copyright The Author(s), 2020. Published by Cambridge University Press. BackgroundWorldwide, governments employ health technology assessment (HTA) in healthcare funding decision making. Requests to include public perspectives in this are increasing, with the idea being that the public can identify social values to guide policy development, increasing the transparency and accountability of government decision making.ObjectiveTo understand the perspectives of the Canadian public on the rationale and design of public involvement in HTA.DesignA demographically representative sample of residents of a Canadian province was selected to take part in two sets of two focus groups (sixteen people for the first set and twenty for the second set).ResultsParticipants were suspicious of the interests driving various stakeholders involved in HTA. They saw the public as uniquely impartial though also lacking knowledge about health technologies. Participants were also suspicious of personal biases and commended mechanisms to reduce their impact. Participants suggested various involvement methods, such as focus groups, citizens\u27 juries and surveys, noting advantages and disadvantages belonging to each and commending a combination.Discussion and conclusionsWe identified a lack of public understanding of how decisions are made and distrust concerning whose interests and values are being considered. Public involvement was seen as a way of providing information to the public and ascertaining their views and values. Participants suggested that public involvement should employ a mixed-methods strategy to support informed debate and participation of a large number of people