Suchergebnisse

This article examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Federal Joint Committee as the regulator. Minimum volumes regulation was inspired by scientific evidence suggesting a positive relationship between service volume and patient outcomes for complex surgical interventions. Federal legislation was introduced in 2002 to delegate the selection of services and the setting of volumes for corporatist decision makers. Yet, despite being represented in the Federal Joint Committee, hospitals affected by its decisions took the Committee to court to seek legal redress and prevent policy implementation. Evidence has been key to support, and challenge, decisions about minimum volumes, including in court. The analysis of the role of scientific evidence in minimum volumes regulation in Germany highlights the dynamic relationship between evidence use and the political and institutional context of health policy making, which in this case is characterized by the legislative nature of policy making, corporatism, and the role of the judiciary in reviewing policy decisions.

There has been a growing global concern for improving the use of evidence to inform health policy in recent years. Increasingly there is recognition that individual projects or programmes building evidence synthesis skills, may be limited in their effect without a broader consideration of the systems in place which 'embed' or 'institutionalise' evidence informed policy making practices (Alliance for Health Policy and Systems Research and WHO 2007). The GRIP-Health programme is a five year project supported by the European Research Council which studies the political nature of health policy to understand how to best improve the use of evidence. This explicitly political lens enables us to focus on the contested nature of health issues as well as the institutions that shape the use of evidence in health policy making. We understand institutions as including both formal structures and rules, as well as informal norms and practices (Lowndes and Roberts 2013). The GRIP-Health programme follows the World Health Organization's view that Ministries of Health remain the ultimate stewards of a nation's health, and further play a key role in providing information to guide health decisions (World Health Organization 2000, Alvarez-Rosette, Hawkins, and Parkhurst 2013). As such, GRIP-Health is particularly concerned with the structures and rules created by government to gather, synthesise, or otherwise provide evidence to inform policy making. This working paper is one of a series of six briefs covering a set of countries in which the GRIP-Health programme is undertaking research. This brief presents an overview of what is termed the 'Evidence Advisory System' (EAS) for health policy making within the country of interest, which is taken to encompass the key entry points through which research evidence can make its way into relevant health policy decisions. This can include both formal (government mandated) and informal structures, rules, and norms in place. Individual reports in this series can be useful for those considering how to improve evidence use in specific country settings, while taken together the reports identify the differences that can be seen across contexts, permitting reflection or comparison across countries about how evidence advisory systems are structured – including which responsibilities are given to different types of bodies, and how well evidence advice aligns with decision making authority structures.

In England, 'policy experiments' are largely synonymous with the use of randomized controlled trials (RCTs) to test whether one policy 'works' better than another. While advocacy of the use of RCTs in public policy presents this as relatively straightforward, even common sense, the reality is different, as shown through analysis of three high profile policy pilots and their evaluations undertaken in health and social care in England in the mid/late 2000s. The RCTs were expected to confirm the direction of policy by resolving any remaining uncertainty about the effectiveness of the chosen path and their existence was used largely as instruments of persuasion. The findings from the analysis of the three pilots confirm the continuing relevance of Campbell's 1969 insight that governments struggle to experiment in the scientific sense and explain the limited effect of these policy experiments on policy decisions.

Healthcare planning forms a key instrument for decision makers to influence and direct health service provision, a function which is likely to become more important in the light of increasingly complex challenges that demand innovative solutions. How this is achieved best and in what circumstances remains however uncertain, given the variety of approaches adopted in different settings. This report aims to contribute to policy learning across countries from the diversity of healthcare planning approaches in Europe and elsewhere through developing and validating a framework for assessing, improving and enhancing healthcare planning. It identifies a set of criteria within three broad themes: "Vision", "Governance" and "Intelligence", which were then tested empirically through an in-depth analysis of four countries, using a case study approach: Germany, Austria, Canada (Ontario) and New Zealand. The analysis provides important insights into how different systems approach healthcare planning, identifying common challenges, but also differences highlighting the very contextual nature within which healthcare planning as an instrument to directing health service provision sits. It will be important to understand the role and power of actors as powerful stakeholder interests are likely to undermine effective planning if there are no mechanisms in place that allow for consensus building and establish lines of accountability for implementation. Broad political goals, such as ensuring economic sustainability, have to be considered and weighed against the goals of healthcare planning. The framework developed presents a first step towards developing a tool for assessing.

Direct payments, i.e. cash payments made directly to the individual in lieu of social care services, have become an established option in council-funded domiciliary care as a means to better personalize care and support. As part of its agenda to modernize social care, the Government tested their use in long-term residential care in 18 trailblazing councils in England. This article presents findings from the independent evaluation of this initiative, using interviews with project leads seconded to the programme in all participating councils, and with council and care home staff involved in implementing direct payments in residential care in five sites. Interviews were conducted between September 2014 and November 2015. They explored professionals' views and experiences of personalization in residential care and their thoughts on the potential contribution of direct payments to promoting personalization. Whilst there was agreement that good care takes personal preferences into account and that many care homes could provide a more personalized service, doubts were voiced about whether direct payments were an appropriate mechanism to achieve this aim. This was seen as particularly pertinent in relation to residents with very high care needs and limited capacity to exercise choice and control. Interviewees also identified a number of risks and challenges to implementation, including financial risks to care homes. The findings from these interviews suggest that the contribution of direct payments to personalizing residential care may be more modest than expected.