Health Policy and the Politics of Evidence

Abstract

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence-based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre-eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision-making in the National Institute for Health and Clinical Excellence (NICE)-an organization established by the British government in  to decide whether selected health technologies should be made available throughout the National Health Service in England andWales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal-founded on a discursive appropriation of the idea of the "common good"-goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision-making.

Understanding the limited impact of economic evaluation in health care resource allocation: A conceptual framework

“…NICE's decisions are justified with reference to evidence but also to the extensive stakeholder consultation undertaken for each appraisal. However, there is a question mark over the compatibility of evidence based and pluralistic approaches to policy decision-making [26] and a danger that evidence -or in this case cost effectiveness analysis -may be retrospectively invoked to support decisions taken on other grounds. There is a need for qualitative exploration of the processes involved in reaching decisions and the role of both evidence and deliberation in that.…”

Knowledge, Power and Politics

“…It is often articulated as 'research-based policy', 'evidence-based policy' or EBP (Hammersley, 2003;Milewa and Barry, 2005;Naughton, 2005). Constructing and defending policy with 'evidence' is ostensibly a positive, worthwhile practice.…”

Representation and legitimacy in health policy formulation at a national level: Perspectives from a study of health technology eligibility procedures in the United Kingdom

“…The second theme was concerned with the impact, if any, of such discursive parameters and assumptions on the framing and prioritisation of evidence. Professional participants were again seen to exercise greater influence not just on the basis of superior knowledge but on an implicit claim to competence in the management of uncertainty [10]. This article focuses upon a third question.…”