Learning through a situation — Stakeholder Seminar
Experience from an MSc Digital Health Student
Before the university lectures ended, the students of MSc Digital Health (including myself) participated in a seminar which required some role-playing. Initiated by our enthusiastic and creative lecturer, Priit Kruus, we were given the opportunity to be a stakeholder in a simulated scenario to navigate through the complexity of healthcare budgeting. It was a form of practice where we could apply our newly acquired knowledge from our autumn studies. The given task was a debate among all stakeholders to decide on the healthcare budget in a fictional country known as ‘Funland’. There was a total of ten different stakeholders for us to pick from. Certain stakeholders were given added responsibility — the Cabinet, the Ministry of Health (MOH) and the State Insurance Fund (SIF) each had to draft the annual budget for the following year as well as for the next 4 years. The outcome of this seminar determined whether the final proposed budget would be supported or opposed by the stakeholders.
Prior to the seminar, each stakeholder was given an opportunity to prepare an opening statement and closing statement. Given that the seminar was held virtually this year, the opening statements were all pre-recorded. The lecturer instructed us to ‘be creative and have fun’. Thus, the videos were cleverly made and at the same time brought out the stands and positions of each stakeholder. One group even put in the effort to dress themselves up and make use of their talented acting skills in their opening statements, which also injected an element of fun to the seminar.
Choosing a Stakeholder
For me, it was not a difficult choice as I chose the stakeholder that I had been reading about and was interested in — the Long-Term Care Provider Association. Long-term care is an emerging issue in real-life, considering that the global population is ageing and there is a rise in the prevalence of chronic illness, making it important to already start planning ahead. Together with those who had also chosen this stakeholder, our main role was to further the interest of providers of long-term care. To give some relevant background context, in the fictional country ‘Funland’, the provision of long-term care services were inadequate and many specialists had left. Most of the patients, who needed long-term care, were not covered by the insurance as the state insurance did not provide any financial help. This in turn resulted in the improper use of hospital emergency services or specialist care for long-term care. In light of the situation, we identified the problems and possible ways to define our position for the providers of long-term care. We decided to argue for more funds to subsidise private health insurance to increase the uptake rates, build more nursing homes in rural regions and provide incentives to entice healthcare workers to work in regions, which were lacking the necessary specialists.
Main Points during the Debate
We had the opportunity to view the pre-recorded opening statements the day before and then it was time to make our arguments for the interest of our chosen stakeholder group. After a short brief by the Priit Kruus, the moderator and facilitator of this seminar, the debate began. There were many good points brought up by different stakeholders within the 2 hours of the debate. The following discussion points that I would like to share, were the most memorable for me or the most relevant for my stakeholder group.
- Almost all the stakeholders were concerned about long-term care services for the population and were advocating for developing them, especially the Local Government Association.
- The Ministry of Health proposed to increase government revenue through land tax, earmarked taxes from employers and employees for more funds and revenue for the government for the healthcare budget. However, the Cabinet was not keen to increase them that quickly within a year.
- The State Insurance Fund proposed a change of hospital payment models with diagnostic related grouping instead of current practice. In addition, they were willing to provide insurance coverage for long-term care instead of subsiding private health insurance for long-term care — an aspect not advocated by the Long-term Care Providers Association.
- The State Insurance Fund also intended to impose penalties for specialists who did not provide continuity of care for patients — a position strongly opposed by the Specialist and Hospital Doctor’s Association.
- Digital Health Industry was seeking for more funds in view of the rising need for digitalization of healthcare IT systems from the Ministry of Health.
- Private Insurance Association was keen to push forward new plans to improve coverage for the population.
In between the debates, there were also comments made by the media (which in this case was represented by the lecturer) and we had to continuously keep up with the fast pace and new arguments during the seminar. There were also moments, where we got too carried away that the moderator had to intervene due to the time constraints of the seminar. Besides the intense arguments, there were some light-hearted moments, where some tried pragmatic ways to appeal to other stakeholders in providing some concessions, such as proposing of punitive approaches. There were also secret debates that went on behind closed doors (in this case private online conversions), which potentially questioned each stakeholders’ motives. Our team managed to secretly negotiate with the Specialist and Hospital Doctor’s Association for more resources from the State Insurance Fund, and in turn we agreed to support the increase in their funding as well.
After the intense debate, we each had to make our closing statements based on what had been discussed. The last task was for the governing bodies (Cabinet, Ministry of Health and State Insurance Fund) to balance out their proposed budgets. We had the power to vote, whether we support the budget or not. Through online voting, we finally had the results in hand. It was announced… 80–20, in support of the budget and it was successfully passed in the parliament of ‘Funland’!
My Experience in this Simulated Practice
Overall, it was an interesting experience and there were some learning points. Firstly, it had been months that we had such an energetic lesson after hybrid learning was implemented. Even though this format of a debate was non-conventional, where it had to be done all online and via a computer screen, the quality of the reasoning and quick rebuttal was not at all compromised. In fact, the audio was crisp and provided attention to the audience. Secondly, this seminar provided understanding and learning beyond the classroom walls. The issues debated were equally thought-provoking and reflected similarly in real life scenarios. It provided a context of the situation, and my participation felt legitimate, which allowed me to experience the decision-making process. It also sparked me to think deeply and see the perspective of my opposing party before providing my views and arguments. By embedding such an activity in a learning environment, the process felt authentic and I felt more engaged in the seminar, which then allowed me to grasp a better understanding of what I have learned throughout the semester.
