Deliberative democracy: How dialogue structures policy preferences for health system reform.

摘要

Despite normative theoretical claims of the virtues of deliberative democracy, increasing adoption of deliberative designs and growing attention from researchers, there remains a significant gap between theory, practice and empirical understanding of public deliberation. This research addresses how deliberative forums effect changes in policy preferences for health system reform by considering the context and processes of deliberation. Building on a rudimentary conceptual framework based in normative theories of deliberative democracy, quantitative and qualitative analysis of three facilitated dialogues provides insight into the meanings and values that underlie preference shifts as participants are exposed to new information and diverse perspectives.;Devolution of health policy and discretionary spending decisions to states requires that citizens be engaged in decision-making to gain both a better understanding of public preferences and greater stability in public judgment. This research makes a modest contribution to understanding the communicative mechanisms that underlie deliberative outcomes, and suggests how facilitated dialogue among citizens may provide a basis for anticipating how the general public will resolve health policy issues. More broadly, the conceptual framework it advances proposes the efficacy of deliberative forums to broaden civic participation and generate solutions to other policy problems. Insights derived from the analysis and the conceptual framework contribute to an expanded understanding of deliberative democracy that is salient for researchers, public administrators, and health policy analysts and suggest areas for further research.;The findings confirm the significance of deliberative process and content, and add a third distinct dimension which focuses on participants. Within each dimension, key elements salient to the generation of deliberative outcomes were identified. Elements of process included creation of the deliberative environment; facilitators' role; relationship between identity, experience and narratives; and, relative influence of engagement and participation. Elements of content included linkages between facts and values; influence of background information; the nature of participant narratives; reconciliation of divergent perspectives; the nature of reasoned arguments and their contestation. Participant-related elements included individual and shared identity; the relationship between identity and privileged knowledge; and, personal experience of both the health care system and government.