Values. Voice. Individual differences. CHAT aims to engage ordinary persons in informed, inclusive deliberation about complex and value-laden allocation decisions.

So... what actually is CHAT?

...a "serious game." It is designed to be inclusive, informative, and engaging (that is, fun!).

...used to stand for Choosing Healthplans All Together. Since it is now used to engage people in deliberations about health-related priorities of many sorts, CHAT now stands for CHoosing All Together. 

Why use CHAT?

While it may be straightforward to identify injustice in the distribution of limited resources, defining the “right” allocation is difficult. Should we prioritize research on common diseases over rare ones? Quality of life over prolonging life? Preventing “bad” outcomes, curing minor ailments, improving or restoring basic human functioning, or relieving suffering? How should we trade-off research that tests promising interventions and research that aims to improve delivery of proven interventions? These trade-offs require attention to justice and science. Justice is enhanced by the participation in decision making of those most affected by the decisions. 

How does CHAT work?

CHAT depicts spending options as layered wedges on a pie chart. There are up to 16 possible categories of spending, and each category has up to 3 or 4 levels that could be selected. Higher levels cost more, but potentially provide more benefits. Participants use markers to choose among spending options, but there are more marker spaces from which to choose than there are markers. Thus, participants must set priorities for the use of limited resources. Each CHAT session, involving 9-15 individuals led by a professional facilitator, consists of four rounds: 1) Individually, participants choose priorities based on their own concepts of what is most important; 2) Groups of 2-3 work together; 3) The whole group (usually 9-15 people) attempts to reach consensus on spending priorities on behalf of the community; and 4) Individuals again select their own priorities. Repeating individual choices in the final round enables an examination of how participants’ views are affected by group deliberations and the exercise. After rounds one and two, participants receive hypothetical health “events,” exposing them to the consequences of their allocation choices. Participants learn from other members of the group, the illustrative events, and embedded resources and are asked to make fair decisions on behalf of fellow community members.


CHAT Insurance Design Tool, 2005

Michigan Medicaid CHAT, 2016

Community Health Benefit CHAT, 2019