The dilemma of knowledge use in political decision-making: National Guidelines in a Swedish priority-setting context

Abstract

There is a growing recognition of the importance of evidence to support allocative policy decisions in health care. This study is based on interviews with politicians in four regional health authorities in Sweden. Drawing on theories of strategic use of knowledge, the article analyses how politicians perceive and make use of expert knowledge represented by the National Guidelines, embracing both a scientific and a political rationale. As health care is an organisation with a dual basis for legitimacy - at the same time a political and an action organisation - it affects knowledge use. We investigate how the context of health care priority setting influences the conditions for knowledge use among regional politicians. Our findings illustrate the dilemma of political decision-makers and how they prefer to use expert knowledge. The politicians use this policy instrument in a legitimising fashion, as it will fit into the current political debate on more equal care. As an instrument for resource allocation the politicians noted that 'facts' per se could not provide them with a sufficient basis for legitimising their governing of health care. The dualistic organisational context makes knowledge important as a political weapon in negotiations with the medical profession.

Research utilization process model: A cyclical, spiral, and developmental process to provide conclusive research knowledge in health professions education

“…Findings of single primary or secondary research study may not be assumed as conclusive research knowledge, and previous This model distinguished between use and misuse of research. The symbolic and political uses of research knowledge may be seen in organizational decision-making (47). This model categorizes the symbolic and political use of research findings as misuse of research findings The misuse of research disrupts cyclical, spiral, and developmental process of research utilization.…”

The sociology of rationing: Towards increased interdisciplinary dialogue ‐ A critical interpretive literature review

“…Related to these studies are ones that demonstrate how social phenomena are co‐constituted with rationing, including scarcity (Chabrol et al., 2017), disinvestment (Rooshenas et al., 2015), exceptionality (Hughes & Doheny, 2019), death (Timmermans, 1999), life longevity (Kaufman, 2009) and patient deservingness (Hughes & Doheny, 2019; Rhodes et al., 2019; Vassy, 2001). The second type describes how social dynamics shape rationing decisions, focussing on different aspects and levels of social dynamics, including national contexts (Gross, 1994; Stanton, 1999; Wells, 2003), organisational factors (Calnan et al., 2017; Hughes & Griffiths, 1997; Prior, 2001; Sandberg et al., 2018) and doctors' professional judgement (Gross, 1994; Hedgecoe, 2006; Klein et al., 1995). The third type analyses the steps taken by organisations or individuals to navigate through ‘the layers of complexity and uncertainty’ in making PSR decisions (Calnan et al., 2017; Hughes & Doheny, 2019; Sjögren, 2006; Sjögren, 2008; Syrett, 2007).…”

Preventive health resource allocation decision-making processes and the use of economic evidence in an Australian state government—A mixed methods study

“…Amongst the Organisation for Economic Co-operation and Development (OECD) countries, the use of economic evidence within national Health Technology Assessment processes have been established since the 1990s [13,14]. The importance of evidence, and more specifically economic evidence to improve the rationality of policy decision-making in other healthrelated decision-making contexts has recently gained greater recognition [15,16]. Several studies have examined the use of economic evidence and the enablers and barriers to its use in health policy decision-making [17][18][19][20].…”