An innovative participatory method for newly democratic societies: The “civic groups forum” on national health insurance reform in Taiwan

Echoing the advocates of deliberative methods sensitive to specific socio-political contexts, we designed the “civic groups forum” method and tested it in 2003 in Taiwan. Our goals were to design a participatory method that suited newly democratic countries and to engage people in discussing national health insurance premium reform in Taiwan. This innovative forum emphasized: (1) civic groups as the participants and (2) engaging a moderate number of participants. We combined and modified the methods of the consensus conference and deliberative polling to design the civic groups forum. Comprehensible reading materials, expert lectures, expert testimony, and group discussions were provided to enhance deliberative discussion of policy issues. A total of 74 group representatives from four types of civic groups-health care provider associations, labor unions, social welfare organizations, and patient organizations-participated. We conducted a before-and-after comparison to evaluate the method, using a self-administered questionnaire to collect data on participants' policy preferences, National Health Insurance policy literacy, comments, and socio-demographic characteristics. We also used in-depth interviews and participant observation to collect complementary information. After the forum, the social welfare and the patient organizations showed increased deliberation skills, empowerment, and confidence in policy involvement compared to the health care provider associations and the labor unions. We also found that when participants are civic group representatives, it is suitable to design an open-structured, early involvement, and participant-controlled format.