The project

Visible Fairness provided an opportunity for the public � as health plan members and as citizens � to participate in a community-wide dialogue on the role that cost plays in healthcare treatment and coverage decisions. 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. This 18-month project was funded by the California HealthCare Foundation and included the following components:

Physician survey

The purpose of this survey was to understand the local physicians' perspectives and experiences in making cost-effectiveness decisions in clinical practice.

A written survey was mailed in June 2000 to 1,000 randomly-selected physicians in the five counties of Sacramento, Yolo, El Dorado, Placer and Nevada.  Over 500 surveys were returned for a 52% response rate.

Discussions with consumers

The goal of these discussions was to identify consumer views and values about how decisions should be made when healthcare providers consider the use of medical treatments that have marginal benefit at great cost.

The project conducted 25 small-group discussions with the public between November 2000 and February 2001. Using an interactive discussion format, Visible Fairness challenged 263 individuals to consider some of the priority conflicts facing patients, consumers, and citizens.  Meetings were held in workplace and faith settings, individuals' homes, classrooms, and community organizations.

Consumer phone survey

A 500-person phone survey was conducted in April 2001 to identify how a random sampling of the public views the issue of the rising cost of healthcare and reactions to various cost-containment strategies.

Final report

Cost-Effectiveness as a Criterion for Medical and Coverage Decisions: Understanding and Responding to Community Perspectives (October 2001)

This report includes the surveys and tools used for Visible Fairness, as well as the results and specific recommendations for different stakeholder groups. Contact SHD for a copy of this 32-page report.