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Incorporation of a health economic modelling tool into public health commissioning : evidence use in a politicised context
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Sanders, Tom, Grove, Amy L., Salway, Sarah, Hampshaw, Susan and Goyder, Elizabeth (2017) Incorporation of a health economic modelling tool into public health commissioning : evidence use in a politicised context. Social Science & Medicine, 186 . pp. 122-129. doi:10.1016/j.socscimed.2017.06.011 ISSN 0277-9536.
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Official URL: http://dx.doi.org/10.1016/j.socscimed.2017.06.011
Abstract
This paper explores how commissioners working in an English local government authority (LA) viewed a health economic decision tool for planning services in relation to diabetes. We conducted 15 interviews and 2 focus groups between July 2015 and February 2016, with commissioners (including public health managers, data analysts and council members). Two overlapping themes were identified explaining the obstacles and enablers of using such a tool in commissioning: a) evidence cultures, and b) system interdependency. The former highlighted the diverse evidence cultures present in the LA with politicians influenced by the 'soft' social care agendas affecting their local population and treating local opinion as evidence, whilst public health managers prioritised the scientific view of evidence informed by research. System interdependency further complicated the decision making process by recognizing interlinking with departments and other disease groups. To achieve legitimacy within the commissioning arena health economic modelling needs to function effectively in a highly politicised environment where decisions are made not only on the basis of research evidence, but on grounds of 'soft' data, personal opinion and intelligence. In this context decisions become politicised, with multiple opinions seeking a voice. The way that such decisions are negotiated and which ones establish authority is of importance. We analyse the data using Larson's (1990) discursive field concept to show how the tool becomes an object of research push and pull likely to be used instrumentally by stakeholders to advance specific agendas, not a means of informing complex decisions. In conclusion, LA decision making is underpinned by a transactional business ethic which is a further potential 'pull' mechanism for the incorporation of health economic modelling in local commissioning.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RA Public aspects of medicine | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Health services administration -- Great Britain, Diabetes | ||||||||
Journal or Publication Title: | Social Science & Medicine | ||||||||
Publisher: | Elsevier | ||||||||
ISSN: | 0277-9536 | ||||||||
Official Date: | August 2017 | ||||||||
Dates: |
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Volume: | 186 | ||||||||
Page Range: | pp. 122-129 | ||||||||
DOI: | 10.1016/j.socscimed.2017.06.011 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 20 July 2017 | ||||||||
Date of first compliant Open Access: | 12 June 2018 |
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