DOES THE COMMUNITY WANT DEVOLVED AUTHORITY - RESULTS OF DELIBERATIVE POLLING IN ONTARIO

Objective: To obtain and contrast the informed opinions of people in f ive decision-making groups that could have a role in devolved governan ce of health care and social services. Design: Deliberative polling. S etting: Three rural and three urban communities selected from the 32 a reas covered by a district health council in Ontario. Participants: A total of 280 citizens from five potential decision-making groups: rand omly selected citizens, attendees at town-hall meetings, appointees to district health councils, elected officials and experts in health car e and social services. Intervention: Participants' opinions were polle d during 29 structured 2-hour meetings. Main outcome measures: Partici pants' opinions on their personal willingness and their group's suitab ility to be involved in devolved decision making, desired type of deci sion-making involvement, information preferences, preferred areas of d ecision-making involvement and preferred composition of decisionmaking bodies. Results: Mean attendance at each meeting was 9.6 citizens. Al though there were some significant differences in opinion among the fi ve potential decision-making groups, there were few differences among citizens From different geographic areas. A total of 189 (72%) of peop le polled were personally willing to take on a role involving responsi bility for overall decision-making, but far Fewer thought that their g roup was suited to taking on responsibility (30%) or a consulting role (55%). Elected officials were the most willing (85% personally willin g, 50% thought their group was suitable) and randomly selected citizen s the least willing (60% personally willing, 17% thought their group w as suitable) to take responsibility for overall decision making. Most citizens polled indicated less interest in involvement in specific typ es of decisions, except for planning and setting priorities, than in o verall decision making. Only 24 participants (9%) rated their own grou p as suitable to take responsibility for raising revenue, 91 (33%) dee med their group suited to distribution of funds and 108 (39%) felt the ir group was suitable for management of services. People in all five g roups ranked health care needs (mean rank 1.5 out of four options) as the most important and preferences (mean rank 3.6) as the least import ant information. They rated a combination body involving several commu nity groups as the most suitable overall decisionmaking body (8.8 on 1 0-point scale). Participants favoured the representation of elected of ficials, the provincial government and experts on combination bodies r esponsible for the specific types of decisions. Overall, as the comple xity of devolved decision making became clear, participants tended to assign authority to traditional decision makers such as elected offici als, experts and the provincial government, but also favoured a consul ting role for attendees at town-hall meetings (i.e., interested citize ns). Conclusion: There are significant differences among groups in the community in their willingness to be involved, desired roles and repr esentation in devolved decision making on health care and social servi ces in Ontario.