Rationality versus reality: the challenges of evidence-based decision making for health policy makersReport as inadecuate




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Implementation Science

, 5:39

First Online: 26 May 2010Received: 25 September 2008Accepted: 26 May 2010DOI: 10.1186-1748-5908-5-39

Cite this article as: McCaughey, D. & Bruning, N.S. Implementation Sci 2010 5: 39. doi:10.1186-1748-5908-5-39

Abstract

BackgroundCurrent healthcare systems have extended the evidence-based medicine EBM approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process.

DiscussionWe contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making EBDM and evidence-based policy making EBPM because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers- decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence.

SummaryIn this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM-EBPM process can be improved.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-5908-5-39 contains supplementary material, which is available to authorized users.

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Author: Deirdre McCaughey - Nealia S Bruning

Source: https://link.springer.com/







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