Evidence based policymaking. Policymakers may need to make a break with the past.
Explore the source record for details and available documents.
Health Policy↗
SEARCH · Search PubMed
Results for “Policymakers”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The state rate-setting model: long-range solution or short-term expedient? Issues, evidence, and the policymaker's dilemma.
Explore the source record for details and available documents.
Economics, Hospital↗
The political contexts of evidence-based medicine: policymaking for daily hemodialysis.
Policymakers and clinicians increasingly rely on evidence-based medicine (EBM) to make decisions about insurance coverage and clinical treatment. Conflicting value judgments about evidence and pressures exerted by stakeholders render health policymaking a political process. This paper examines how value judgments become embedded in the process of improving medical outcomes by focusing on health policymaking. Specifically, this paper highlights how EBM is variably used as a standard for decision-making depending on perceived risks by policymakers and what is on the competing agenda. I draw upon the case study of the policymaking process for the recent US bill, H.R. 1004: Kidney Patient Daily Dialysis Act, which would legislate daily hemodialysis (DHD) as a new renal replacement therapy modality, and provide federal medicare funding of hemodialysis from 3 to 6 times per week. DHD constitutes an ideal case study with which to explore the political underpinnings of EBM. The interpretations of substantial outcome data showing medical, quality of life, and hypothetical economic improvements of DHD over conventional dialysis are currently being contested in the medical and political spheres. Accordingly, the drive for what some stakeholders view as better evidence through randomized clinical trials is central to the debate and policymaking process. This paper underscores how the demand for, the interpretations, the funding for, and the use of evidence render EBM a political endeavor with vital ethical implications for clinical care.
Evidence-Based Medicine↗
Policymaker use of quality of care information.
OBJECTIVE: This study describes public policymakers' experiences with the feasibility of using information from quality of care assessment activities. The objective is to improve the ability to match quality evaluation tools with policymakers' information needs. DESIGN: US state administrative policymakers were interviewed about use of quality of care information and knowledge, attitudes, and experiences with information from specific types of measures. PARTICIPANTS: A purposive sample of 82 key informants from Medicaid program administrations in 48 states. MAIN MEASURE: Users of information from each of eight targeted types of quality of care measurement methods were compared with non-users based upon their levels of knowledge, perceived characteristics of quality of care information, and perceived characteristics of the policy situation. RESULTS: Participants indicated that some types of quality measurement methods have been useful, whereas others have not. Extent of quality assessment information use, and the measurement methods utilized, varied widely. Two factors were associated with the use of information from particular quality assessment methods: information needs of the policymakers and their perceptions of the characteristics, including strengths and weaknesses, of particular measurement methods. CONCLUSIONS: These policymakers had positive attitudes about quality assessment, were knowledgeable about types of methods, and had a variety of potential uses for quality-related information. Yet, perceptions and experiences with different types of measurement methods varied. We describe a set of quality assessment methods with complementary characteristics that could provide a relatively inclusive picture of quality of care and better address policymaker information needs.
Cross-Sectional Studies↗
Examining the role of health services research in public policymaking.
Conceptual, methodological, and practical issues await those who seek to understand how to make better use of health services research in developing public policy. Some policies and some policymaking processes may lend themselves particularly well to being informed by research. Different conclusions about the extent to which policymaking is informed by research may arise from different views about what constitutes health services research (is it citable research or any professional social inquiry that can aid in problem solving?) or different views about what constitutes research use (is it explicit uses of research only, or does it also include tacit knowledge or the positions of stakeholders when they are informed by research and are influential in the policymaking process?). Some conditions may favor the use of research in policymaking, like sustained interactions between researchers and policymakers. Results from an exploratory study on the use of health services research by Canadian provincial policymakers illustrate these issues.
Advisory Committees↗
Physician, public, and policymaker perspectives on chronic conditions.
BACKGROUND: Chronic conditions are the leading reason why people seek medical care, yet the current financing and delivery system has been criticized for not promoting ongoing care. The perceptions of physicians, policymakers, and the general public were compared on how well the current system addresses the needs of people with chronic conditions. METHODS: National surveys of 1238 physicians and 1663 Americans and a convenience sample of 155 policymakers were compared. All 3 groups were given the same definition of a chronic condition and asked similar questions. RESULTS: There was strong agreement that chronic medical conditions affect men and women of all ages, ethnicities, and income levels (>90% strongly or somewhat agree). However, compared with the public and physicians, policymakers were less likely to respond that people with chronic conditions usually receive adequate medical care, that health insurance pays for most needed services, or that government programs are adequate. The public was most positive about the current system and policymakers the least. A majority of all 3 groups agreed that it is somewhat or very difficult for people with chronic conditions to obtain adequate care from primary care physicians, medical specialists, and other health care professionals. CONCLUSIONS: A majority of physicians, policymakers, and the general public are concerned that the current health care system is not addressing the needs of people with chronic conditions. Changes in how medical care is financed and delivered are necessary to respond to these concerns.
Adult↗
Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges.
Public policymakers must contend with a particular set of institutional arrangements that govern what can be done to address any given issue, pressure from a variety of interest groups about what they would like to see done to address any given issue, and a range of ideas (including research evidence) about how best to address any given issue. Rarely do processes exist that can get optimally packaged high-quality and high-relevance research evidence into the hands of public policymakers when they most need it, which is often in hours and days, not months and years. In Canada, a variety of efforts have been undertaken to address the factors that have been found to increase the prospects for research use, including the production of systematic reviews that meet the shorter term (but not urgent) needs of public policymakers and encouraging partnerships between researchers and policymakers that allow for their interaction around the tasks of asking and answering relevant questions. Much less progress has been made in making available research evidence to inform the urgent needs of public policymakers and in addressing attitudinal barriers and capacity limitations. In the future, knowledge-translation processes, particularly push efforts and efforts to facilitate user pull, should be undertaken on a sufficiently large scale and with a sufficiently rigorous evaluation so that robust conclusions can be drawn about their effectiveness.
Canada↗
Use of research to inform public policymaking.
To improve health and reduce health inequalities, public policymakers need to find the best solutions to the most burdensome health problems, the best ways to fit these solutions into complex and often overstretched and underresourced health systems, and the best ways to bring about the desired changes in health systems. Systematic reviews can inform public policymaking by providing research-based answers to these questions. Public policymakers can encourage more informed policymaking by asking to see systematic reviews on priority issues, commissioning reviews when none exists, and placing more value on such work in their deliberations and in their interactions with stakeholders. Donors and international agencies can encourage more informed public policymaking by supporting national and regional efforts to undertake reviews and assess their local applicability, and by supporting regional or worldwide efforts to coordinate review and assessment processes.
Health Policy↗
Influencing policymaking for maltreated children and their families.
Public policy can be a powerful tool for children and their families. Accordingly, this article addresses how psychologists and other child-oriented researchers can leverage this tool to ensure that child and family issues, specifically issues related to child abuse and neglect, receive adequate attention. We encourage a bidirectional relationship between policymakers and experts in child maltreatment through which policymakers solicit and employ relevant expertise, and psychologists, in turn, provide useful information to policymakers. To facilitate such relationships, this article offers practical guidance to psychologists on understanding the policymaking process, gaining familiarity with relevant policy, communicating effectively with policymakers, and understanding the unique contributions that psychologists can make to the policy process.
Child↗
Flint Photovoice: community building among youths, adults, and policymakers.
Flint Photovoice represents the work of 41 youths and adults recruited to use a participatory-action research approach to photographically document community assets and concerns, critically discuss the resulting images, and communicate with policymakers. At the suggestion of grassroots community leaders, we included policymakers among those asked to take photographs. In accordance with previously established photovoice methodology, we also recruited at the project's outset another group of policymakers and community leaders to provide political will and support for implementing photovoice participants' policy and program recommendations. Flint Photovoice enabled youths to express their concerns about neighborhood violence to policymakers and was instrumental in acquiring funding for local violence prevention. We note salutary outcomes produced by the inclusion of policymakers among adults who took photographs.
Adolescent↗
Determinants of health policy impact: comparative results of a European policymaker study.
OBJECTIVES: This article will use a new theoretical framework for the analysis of health policy impact introduced by Rütten et al. (2003). In particular, it will report on a comparative European study of policymakers' perception and evaluation of specific determinants of the policy impact, both in terms of output (implemented measures) and outcome (health behaviour change). Policy determinants investigated are goals, resources, obligations and opportunities as related to the policymaking process. METHODS: Theory is applied to a comparative analysis of prevention and health promotion policy in Belgium, Finland, Germany. The Netherlands, Spain and Switzerland. The study is MED2-part of a project that has developed a Methodology for the Analysis of the Rationality and Effectiveness of Prevention and Health Promotion Strategies (MAREPS) within the EU-BIO-program. A mail survey of 719 policymakers on the executive and administrative level selected by a focused sample procedure was conducted. This survey used policymakers' experience and evaluative expertise to analyse determinants of policy output and outcome. RESULTS: Regression analyses reveal differential predictive power of policy goals, resources, obligations, as well as of political, organisational and public opportunities. For instance, whereas resources, concreteness of goals, and public opportunities have significant importance for health outcome of policy, obligations and organisational opportunities significantly predict policy output. CONCLUSIONS: Results are discussed in terms of rationality and effectiveness of health policy. They indicate that six sensitising constructs derived from the theoretical framework represent equivalent structures across nations. They comprise a validated instrument that can be used for further comparative health policy research.
Europe↗
The affordability of antiretroviral therapy in developing countries: what policymakers need to know.
OBJECTIVE: The objective of this paper is to assist policymakers in developing countries and international donors by providing an outline of economic information needed to make a decision regarding the purchase of drugs to provide highly active antiretroviral therapy (HAART). DESIGN: The following paper: (i) reviews existing experiences of policymakers in developing countries regarding the purchase of drugs needed for HAART, (ii) identifies issues that would need to be addressed and data that would be required to make more informed decisions regarding this issue, (iii) develops a cost-benefit model that could be utilized in designing an economic research project evaluating the economic costs and benefits of HAART, and (iv) performs a preliminary test of this model with data from Costa Rica. RESULTS: A review of experiences with this issue reveals that there are growing political, legal and budgetary pressures for countries to make tenable decisions regarding the purchase of drugs for HAART. An economic model describing the costs and benefits of HAART is proposed, although much of the required data for using such a model is currently neither available or in the process of being collected. CONCLUSIONS: It is imperative that economic data be collected to better inform policymakers in developing countries about their decision regarding the purchase of these drugs. It is recommended that such economic data be collected as organizations such as the United Nations Joint Programme on HIV/ AIDS (UNAIDS) initiate their medical assessments of HAART in developing countries.
Anti-HIV Agents↗
What policymakers need and must demand from research regarding the employment rate of persons with disabilities.
Enabling persons with disabilities to prepare for and engage in gainful employment has become a priority concern in U.S. society. As a result, federal and state policymakers are adopting employment-related initiatives designed to enhance the employment rate of persons with disabilities. Policymakers need credible evidence in order to assess and reform these initiatives. This recognized need, however, begs the question of what constitutes 'credible evidence.' Of particular concern in the disability policy arena is the debate over the types of conclusion about employment rates that can and cannot be drawn from analyses of national survey data sets. This article connects standard research methodology concepts with the complexities of evaluating disability policy to help stakeholders appreciate the issues involved in this debate. This appreciation can help policymakers (1) recognize unwarranted cause-and-effect conclusions based solely on existing national survey data and (2) demand better data and stronger research designs to complement the potential over-reliance on correlational studies using problematic survey data to estimate policy impacts. To this end, the article concludes with a practical framework with a checklist for assessing the adequacy of research regarding the employment rate of persons with disabilities.
Persons with Disabilities↗
Policymakers' views on dengue fever/dengue haemorrhagic fever and the need for dengue vaccines in four southeast Asian countries.
A survey of policymakers and other influential professionals in four southeast Asian countries (Cambodia, Indonesia, Philippines and Vietnam) was conducted to determine policymakers' views on the public health importance of dengue fever and dengue haemorrhagic fever (DHF), the need for a vaccine and the determinants influencing its potential introduction. The survey, which involved face-to-face interviews with policymakers, health programme managers, researchers, opinion leaders and other key informants, revealed an almost uniformly high level of concern about dengue fever/DHF and a high perceived need for a dengue vaccine. Several characteristics of the disease contribute to this high sense of priority, including its geographic spread, occurrence in outbreaks, the recurrent risk of infection each dengue season, its severity and the difficulty in diagnosis and management, its urban predominance, its burden on hospitals, and its economic toll on governments and families. Research felt to be key to future decision-making regarding dengue vaccine introduction include: disease surveillance studies, in-country vaccine trials or pilot projects, and studies on the economic burden of dengue and the cost-effectiveness of dengue vaccines. The results suggest favourable conditions for public and private sector markets for dengue vaccines and the need for creative financing strategies to ensure their accessibility to poor children in dengue-endemic countries.
Asia, Southeastern↗
Practical guidelines for educating policymakers: the family impact seminar as an approach to advancing the interests of children and families in the policy arena.
Psychologists are well positioned to contribute to policymaking on issues affecting the well-being of children, youth, and families. A good deal of psychological research is relevant to policy issues such as child mental health services, child care, adoption and foster care, and children's media. In this article we offer an alternative to direct policy advocacy as a means for psychologists' involvement in the policy arena. Policy education, a nonpartisan and nonadversarial approach to working with policymakers, is described and differentiated from child advocacy. We then present an example of 1 approach to policy education, the Family Impact Seminar. The article closes with a discussion of lessons we have learned regarding effectively communicating research to policymakers.
Child↗
How consumers and policymakers can use systematic reviews for decision making.
Systematic reviews can be a very useful decision-making tool because they objectively summarize large amounts of information, identify gaps in medical research, and identify beneficial or harmful interventions. Consumers can use systematic reviews to help them make health care decisions. Policymakers can use systematic reviews to help them make decisions about what types of health care to provide. Despite the potential value of systematic reviews, little evidence of their direct impact on the decisions made by consumers and policymakers is available. We discuss strategies for optimizing the use of systematic reviews by increasing the awareness and identification of reviews, learning to critically evaluate the findings of reviews, and overcoming barriers to the incorporation of reviews into the decision-making process. In addition, the participation of consumers and policymakers in the design, conduct, and reporting of systematic reviews can help to produce reviews that are relevant and understandable to target audiences. Because decisions that involve health care policies and issues are complex processes in which information (such as that provided by systematic reviews) plays only a part, strategies for increasing the use of systematic reviews should be evaluated for their usefulness in the decision-making process.
Decision Making↗
2002 Connecticut health policymaker survey.
In Spring 2002, Connecticut health policymakers in executive and legislative branches of government were surveyed to assess their needs for health policy information and their perceptions of upcoming health challenges facing Connecticut citizens; a similar survey was conducted in 2000. Policymakers receive information from a wide variety of sources; most often from within state government--state agencies and legislative staff--and from health advocacy organizations/coalitions. The most trusted sources of information are legislative staff, journals/publications, and state agencies. The areas of greatest need for information were: health-care financing, the uninsured, prescription drug coverage, long-term care, and mental health/substance abuse. Between 2000 and 2002, concerns over the costs of health care have increased significantly. Connecticut policymakers prefer to receive information in short, one, or two-page fact sheets.
Connecticut↗
On the front lines of policymaking.
We generally associate policies with specific issues. But policies are made by people--frequently by politicians. And the policymaking process is often best explored through the stresses and strains that the process exerts on policymakers. To illustrate more clearly the thinking processes of policymakers and the choices they must make daily, Hospitals' contributing editor Emily Friedman followed a respected health policy leader through a typical day.
Health Policy↗