Influencing Decisions of Value in Health: A Response to Recent Commentaries

Williams, Iestyn; Brown, Hilary; Healy, Paul M.

doi:10.15171/ijhpm.2018.116

Cited by 1 publication

(1 citation statement)

References 7 publications

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“…3,[10][11][12][13][14][15][16] What this umbrella of contextual factors holds exactly has recently attracted scholarly interest for 'decisions of value' in the healthcare field. [17][18][19][20] Williams et al initiated the discussion with a literature review focused on meso-level decisionmaking, exploring both 'inner' and 'outer' contexts and how these may affect such decisions of value. 14 Many of the papers reviewed by Williams et al give 'context' as a relatively abstract explanation, and as something that is not necessarily visible in the final decision document.…”

Section: Introductionmentioning

confidence: 99%

Around the Tables – Contextual Factors in Healthcare Coverage Decisions Across Western Europe

Kleinhout-Vliek

Bont

Boysen

et al. 2020

Int J Health Policy Manag

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Background: Across Western Europe, procedures and formalised criteria for taking decisions on the coverage (inclusion in the benefits basket or equivalent) of healthcare technologies vary substantially. In the decision documents, which display the justification of, the rationale for, these decisions, national healthcare institutes may employ ‘contextual factors,’ defined here as situation-specific considerations. Little is known about how the use of such contextual factors compares across countries. We describe and compare contextual factors as used in coverage decisions generally and 4 decision documents specifically in Belgium, England, Germany, and the Netherlands. Methods: Four group interviews with 3 experts from the national healthcare institute of each country, document and web site analysis, and a workshop with 1 to 2 of these experts per country were followed by the examination of the documents of 4 specific decisions taken in each of the 4 countries, sampled to vary widely in type of technology and decision outcome. Results: From the available decision documents, we conclude that in every country studied, contextual factors are established ‘around the table,’ ie, in deliberation. All documents examined feature contextual factors, with similar contextual factor patterns leading to similar decisions in different countries. The Dutch decisions employ the widest variety of factors, with the exception of the societal functioning of the patient, which is relatively common in Belgium, England, and Germany. Half of the final decisions were taken in another setting, with the consequence that no documentation was retrievable for 2 decisions. Conclusion: First, we conclude that in these countries, contextual factors are actively integrated in the decision document, and that this is achieved in deliberation. Conceptualising contextual factors as both situation-specific and actively-integrated affords insight into practices of contextualisation and provides an encouragement for exchange between decision-makers on more qualitative aspects of decisions. Second, the decisions that lacked a publicly accessible justification of the final decision document raised questions on the decisions’ legitimacy. Further research could address patterning of contextual factors, elucidate why some factors may remain implicit, and how decisions without a publicly available decision document may enable or restrain decision-making practice.

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