Today's healthcare policy issues are rife with conflicting priorities and uncomfortable trade-offs. Capturing the public's voice requires deliberative processes: exposing individuals to unbiased information, feasible options, an opportunity to present one's views and understand the views of others. This is the heart of what we do.

Since 1994, CHCD has conducted the following public deliberation projects:

Hospital Quality: how and why the public cares about certain quality domains (2010). When weighing the impact of different quality domains, California consumers regard patient safety as most important for hospitals to address. This CHCD report has been distributed nationally to organizations sponsoring hospital public-reporting websites.

What Matters Most: the public's priorities for healthcare coverage (2009). Californians identified the characteristics of medical problems that make them most essential for coverage – and those that are less essential. Findings were reported in Congressional Quarterly, Talk of the Nation and other national media outlets.

Getting Good Value: debating costly treatments - is the gain worth the expense? (2006). The public does not reject the concept of cost-effectiveness as a criterion for coverage decisions; getting the most from public dollars is a high priority (more so than ‘saving money.’) These results were reported in Health Affairs and to an AHRQ-sponsored committee.

CHAT (Choosing Health Plans Altogether): designing coverage with limited resources. CHAT is a computer-based two-hour facilitated group exercise that exposes individuals to the challenge of designing a health plan that will meet the needs of many people when resources are constrained. CHCD is used as an educational tool; to identify the public values and priorities; and to provide input to policymakers and healthcare leaders.

• Just Coverage (2006-07). To define ‘basic’ coverage, more than 900 insured and uninsured Californians identified the core components of an essential health plan.

• Medi-Cal CHAT (2004). Adults with disabilities identified the trade-offs they regarded as most acceptable if budget cuts are necessary in California. Results were shared with leaders at the Department of Health Care Services.

• Capitol Region CHAT (2003). 71 local companies learned their employees’ priorities regarding trade-offs in health plan benefit design. Employers sought this information as they faced increased costs of coverage.

Visible Fairness: should cost be a factor in deciding how to allocate health plan dollars? (2002). Designed to ‘test’ with the public the notion of cost-effectiveness as a component of medically necessary care, this was an extension of Stanford University’s seminal report on Defining Medical Necessity. Results were presented in CA and national venues.

ECHO (Extreme Care, Humane Options): guidelines on treatment for those near the end of life (1994-97). A regional multi-hospital project to improve care given to patients who are terminally ill. Following 92 community discussion groups and multiple committees of healthcare providers, 14 of 15 local hospitals implemented the ECHO Recommendations.