Thursday, January 3, 2013

Why government health policy fails

Austin Frakt links to a qualitative study on why evidence-based policy so often loses out:
I’m pleased to write that an ungated PDF of “‘Developing Good Taste in Evidence’: Facilitators of and Hindrances to Evidence-Informed Health Policymaking in State Government,” by Christopher Jewell and Lisa Bero, is available. Anybody interested in why evidence often fails to penetrate the policymaking process should read it, though it is depressing. Here are some quotes, some of which are from interviews conducted by the authors:
  • One official observed that in assessing the effectiveness of a new medical procedure, “I just did exactly what . . . everyone . . . is hoping I’m not. I talked to my brother-in-law and I Googled it.”
  • In reference to medical malpractice reform, one official discussed the problem with having a legislature with a large contingent of trial lawyers: “Right now you’ve got a bunch of people who could care less about the evidence unless they can manipulate it. . . . They know where their economic interests are . . . and that will trump any kind of evidence.”
  • “And you can always find somebody on the committee that’s had some bad experience and so they’re perfectly willing to tell their story, and then fifteen lobbyists stand up and talk about how different people have been harmed by this sort of legislation. . . . And they aren’t studies . . . the lobbyists even lie . . . I mean they make up stories that don’t exist.”
  • An effort to institute a system to use encrypted state health data to analyze variations in medical practice—an issue that does not affect consumers directly—met with significant opposition on the grounds that “even if you don’t identify the individual, you somehow have violated the person because you were looking at the medical record.”
  • “If the leadership in your governing body believes that government should have as limited a role as possible in providing health services to your state population, then it doesn’t matter what you say. . . . They don’t care about evidence because they don’t believe that government should have a role in providing health care.”

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