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Legislating Patient Representation: A Comparison Between Austrian and German Regulations on Self-Help Organizations as Patient Representatives

  • Symposium: Collective Representation in Healthcare Policy
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Abstract

Governments are increasingly inviting patient organizations (POs) to participate in healthcare policymaking. By inviting POs that claim to represent patients, representation comes into being. However, little is known about the circumstances under which governments accept POs as patient representatives. Based on the analysis of relevant legislation, this article investigates the criteria that self-help organizations (SHOs), a special type of PO, must fulfil in order to be accepted as patient representatives by governments in Austria and Germany. Thereby, it aims to contribute to the discussion on the role of governments in steering SHOs. There are different degrees of regulation (very little in Austria, more in Germany). Governments in both countries not only formulate explicit criteria for SHOs with respect to patient representation but also guide SHOs representing patients through implicit criteria for associations. We discuss the findings against concepts of responsiveness, authorization, and accountability. Our findings indicate that governmental steering is not negative per se as indicated by previous research but—depending on legislative criteria—can promote transparency and democratic quality in patient representation.

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References

  • APA. 2009. Stopp: “Wildwuchs” an Patienten-Selbsthilfegruppen. Die Presse, April 2. http://diepresse.com/home/leben/gesundheit/466868/Wildwuchs-an-Selbsthilfegruppen-. Accessed May 10, 2018.

  • Baggott, R., J. Allsop, and K. Jones. 2005. Speaking for patients and carers. Health consumer groups and the policy process. Hampshire: Palgrave.

  • Baggott, R., and R. Forster. 2008. Health consumer and patients’ organizations in Europe: Towards a comparative analysis. Health Expectations 11(1): 85–94.

  • Baggott, R., and K. Jones. 2015. The big society in an age of austerity: Threats and opportunities for health consumer and patients’ organizations in England. Health Expectations 18(6): 2164–2173.

  • Bovens, M. 2007. Analysing and assessing accountability. A conceptual framework. European Law Journal 13(4): 447–468.

  • Branckaerts, J., and A. Richardson. 1988. Politics and policies on self-help: Notes on the international scene. Health Promotion International 2(3): 276–282.

  • Charles, C., and S. DeMaio. 1993. Lay participation in health care decision making: A conceptual framework. Journal of Health Politics, Policy and Law 18(4): 881–904.

  • Chaudhary, S., M. Avis, and C. Munn-Giddings. 2013. Beyond the therapeutic: A Habermasian view of self-help groups’ place in the public sphere. Social Theory & Health 11(1): 59–80.

  • Colombo, C., P. Mosconi, W. Villani, and S. Garattini. 2012. Patient organizations’ funding from pharmaceutical companies: Is disclosure clear, complete and accessible to the public? An Italian survey. PLoS ONE 7(5): 5–6.

  • Forster, R. 2015. Gutachten zur Bürger- und Patientenbeteiligung im österreichischen Gesundheitssystem im Auftrag der ARGE Selbsthilfe Österreich. Wien.

  • ----. 2016. Bürger- und Patientenbeteiligung im Gesundheitssystem. Teil 1: Was sind die zentralen Fragen für Politik und Praxis und was lässt sich aus internationalen Erfahrungen lernen? [Citizen and patient participation in the health system. Part 1: What are the central questions for policy and practice and what can be learned from international experience?]. Soziale Sicherheit 3: 116–123.

  • Keizer, B., and R. Bless. 2010. Pilot study on the position of health consumer and patients’ organisations in seven EU countries. The Hague.

  • Kelleher, D. 2006. Self-help groups and their relationship to medicine. In Challenging medicine, edited by D. Kelleher, J. Gabe, and G. Williams, 104–121. London and New York: Routledge.

  • Löfgren, H., E. de Leeuw, and M. Leahy, eds. 2011. Democratizing health: Consumer groups in the policy process. Cheltenham, UK, Northampton, MA, USA: Edward Elgar Publishing.

  • Mayring, P. 2010. Qualitative Inhaltsanalyse. Grundlagen und Techniken [Qualitative content analysis. Basics and techniques]. Weinheim und Basel: Beltz Verlag.

  • Montanaro, L. 2012. The democratic legitimacy of self-appointed representatives. The Journal of Politics 74(4): 1094–1107.

  • O’Donovan, O. 2007. Corporate colonization of health activism? Irish health advocacy organizations’ modes of engagement with pharmaceutical corporations. International Journal of Health Services 37(4): 711–733.

  • Pitkin, H. 1967. The concept of representation. Berkeley: University of California Press.

  • Ritchie, J., L. Spencer, and W. O’Connor. 2003. Carrying out qualitative analysis. In Qualitative research practice. A guide for social science students and researchers, edited by J. Ritchie and J. Lewis, 219–262. London, Thousand Oaks, New Delhi: Sage.

  • Rojatz, D. 2016. Kollektive Patientenbeteiligung als (Heraus-)Forderung. Eine qualitative Analyse von Selbsthilfeorganisationen zur Reflexion ihrer Möglichkeiten und Grenzen. Dissertation, Universität Wien.

  • Saltman, R., R. Busse, and J. Figueras. 2004. Social health insurance systems in western Europe. Open University Press.

  • Saward, M. 2010. The representative claim. Oxford, New York: Oxford University Press.

  • Schicktanz, S. 2015. The ethical legitimacy of patient organizations’ involvement in politics and knowledge production. Epistemic justice as conceptual basis. In Public shaping of medical research, edited by P. Wehling, W. Viehöver, and S. Koenen, 246–264. New York: Routledge.

  • Schulz-Nieswandt, F., and F. Langenhorst. 2015. Gesundheitsbezogene Selbsthilfe in Deutschland. Zu Genealogie, Gestalt, Gestaltwandel und Wirkkreisen solidargemeinschaftlicher Gegenseitigkeitsselbsthilfegruppen und der Selbsthilfeorganisationen [Health-related self-help in Germany. On genealogy, shape, shape change and spheres of action of solidarity-based mutual self-help groups and self-help organisations]. Berlin: Duncker & Humblot.

  • Souliotis, K., L. Peppou, E. Agapidaki, C. Tzavara, D. Debiais, S. Hasurdjiev, and F. Sarkozy. 2017. Health democracy in Europe: Cancer patient organization participation in health policy. Health Expectations (September): 1–11.

  • Trojan, A., and C. Kofahl. 2011. Selbsthilfe, Selbsthilfegruppen und Selbsthilfeförderung [Self-help, self-help groups, self-help support]. In Leitbegriffe der G esundheitsförderung und P rävention. Glossar zu Konzepten, Strategien, und Methoden [Guiding concepts of health promotion and prevention. Glossary of concepts, strategies and methods], herausgegeben von BZgA, 491–496. Werlach-Gamburg: Verlag für Gesundheitsförderung.

  • Urbinati, N., and M.E. Warren. 2008. The concept of representation in contemporary democratic theory. Annual Review of Political Science 11(1): 387–412.

  • Van de Bovenkamp, H.M., and M.J. Trappenburg. 2011. Government influence on patient organizations. Health Care Analysis 19(4): 329–351.

  • Van de Bovenkamp, H.M., M.J. Trappenburg, and K. Grit. 2010. Patient participation in collective healthcare decision making: The Dutch model. Health Expectations 13(1): 73–85.

  • Van de Bovenkamp, H.M., and H. Vollaard. 2018. Representative claims in health care: Identifying the varied nature of patient representation. Journal of Bioethical Inquiry 15(3) https://doi.org/10.1007/s11673-018-9861-x.

  • ----. 2017. Representative claims in practice: The democratic quality of decentralized social and healthcare policies in the Netherlands. Acta Politica. Palgrave Macmillan UK.

  • Vitry, A., and H. Löfgren. 2011. Health consumer groups and the pharmaceutical industry: Is transparency the answer? In Democratizing health. Consumer groups in the policy process, edited by H. Löfgren, E. de Leeuw, and M. Leahy, 223–254. Cheltenham, UK; Northampton, USA: Edward Elgar.

  • Waardenburg, M., and H.M. Van de Bovenkamp. 2014. Manufacturing civil society. In Manufacturing civil society: Principles, practices and effects, edited by T. Brandsen, W. Trommel, and B. Verschuere, 70–95. Houndmills: Palgrave Macmillan.

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Correspondence to Daniela Rojatz or Julia Fischer.

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Rojatz, D., Fischer, J. & Van de Bovenkamp, H. Legislating Patient Representation: A Comparison Between Austrian and German Regulations on Self-Help Organizations as Patient Representatives. Bioethical Inquiry 15, 351–358 (2018). https://doi.org/10.1007/s11673-018-9864-7

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  • DOI: https://doi.org/10.1007/s11673-018-9864-7

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