These frameworks build on the imbalances in the strengths both within and between groups. Consumers, unlike physicians and drug companies, are poorly served by current arrangements and would gain greatly from a differently organized system. They have enormous difficulty organizing for change. The second framework builds on policy oriented learning. This approach looks at why and how coalitions form and work to alter policy and how creating opportunities for public debate among coalitions can change beliefs, foster learning and affect change.
Several frameworks focus on levels of consumer participation.
One suggests that consumers have different levels of experience and expertise and that processes to involve them need to take this into consideration. A final framework illustrates different assumptions associated with how consumer involvement is perceived. The last five years have seen several new opportunities for increased consumer involvement in health care decision-making. Regionalization was at least partly envisioned to facilitate greater local community participation and better decision-making. The Cochrane Collaboration is an international attempt to review the research literature on the effectiveness of health care interventions in order to derive policy directions.