Who contextualises clinical epidemiological evidence? A political analysis of the problem of evidence-based medicine in the layered Dutch healthcare system

Martijn Felder*, Hester van de Bovenkamp, JW Meerding, Antoinette de Bont

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
38 Downloads (Pure)

Abstract

We critically examine the discussion on the role of evidence-based medicine (EBM) in healthcare governance. We take the institutionally layered Dutch healthcare system as our case study. Here, different actors are involved in the regulation, provision and financing of healthcare services. Over the last decades, these actors have related to EBM to inform their actor specific roles. At the same time, EBM has increasingly been problematised. To better understand this problematisation, we organised focus groups and interviews. We noticed that particularly EBM’s reductionist epistemology and its uncritical use by ‘professional others’ are considered problematic. However, our analysis also reveals that something else seems to be at stake. In fact, all the actors involved underwrite EBM’s reductionist epistemology and emphasise that evidence should be contextualised. They however do so in different ways and with different contexts in mind. Moreover, the ways in which some actors contextualise evidence has consequences for the ways in which others can do the same. We therefore emphasise that behind EBM’s scientific problematisation lurks a political issue. A dispute over who should contextualise evidence how, in a layered healthcare system with interdependent actors that cater to both individual patients and the public. We urge public administration scholars and policymakers to open-up the political confrontation between healthcare actors and their sometimes irreconcilable, yet evidence-informed perspectives.
Original languageEnglish
Pages (from-to)34-40
Number of pages7
JournalHealth Policy
Volume125
Issue number1
DOIs
Publication statusPublished - Jan 2021

Bibliographical note

Funding Information:
This work was financially supported by the ‘Vereniging van Artsen Automobilisten’ (VvAA) , a member organisation and insurer for healthcare professionals in the Netherlands. The data used in this paper has been gathered during the development of a policy advice by the ‘Raad voor de Volksgezondheid en Samenleving (RVenS). See further, materials and methods section.

Publisher Copyright:
© 2020 The Author(s)

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