Citizens' perspectives on disinvestment from publicly funded pathology tests: a deliberative forum

Background Deliberative forums can be useful tools in policy decision making for balancing citizen voice and community values against dominant interests. Objective To describe the use of a deliberative forum to explore community perspectives on a complex health problem—disinvestment. Methods A deliberative forum of citizens was convened in Adelaide, South Australia, to develop criteria to support disinvestment from public funding of ineffective pathology tests. The case study of potential disinvestment from vitamin B12/folate pathology testing was used to shape the debate. The forum was informed by a systematic review of B12/folate pathology test effectiveness and expert testimony. Results The citizens identified seven criteria: cost of the test, potential impact on individual health/capacity to benefit, potential cost to society, public good, alternatives to testing, severity of the condition, and accuracy of the test. The participants not only saw these criteria as an interdependent network but also questioned “the authority” of policymakers to make these decisions. Conclusions Coherence between the criteria devised by the forum and those described by an expert group was considerable, the major differences being that the citizens did not consider equity issues and the experts neglected the “cost” of social and emotional impact of disinvestment on users and the society.