What counts and how to count it: Physicians’ constructions of evidence in a disinvestment context
Open accessAbstract
Internationally, there is an increasing focus on quality and sustainability measures oriented to reducing inefficiencies in health provision. The use of assisted reproductive technologies (ART) for older women represents a case study in this area. This paper analyses the constructions of evidence brought to bear by ART physicians in the context of deliberative stakeholder engagements (held 2010) around options for restricting public subsidy of ART in Australia. Physicians participated in two deliberative engagements during which they were presented with results of a systematic review of ART effectiveness, as well as ethical and cost analyses. These sessions were part of a broader research program of engagements held with policymakers, community members and consumers. Physicians deliberated around the data presented with a view to formulating an informed contribution to policy. The ensuing discussions were transcribed and subject to discourse analysis. Physicians questioned the evidence presented on the grounds of 'currency', 'proximity', 'selectivity' and 'bias'. We outline physicians' accounts of what should count as evidence informing ART policy, and how this evidence should be counted. These accounts reflect implicit decisions around both the inclusion of evidence (selection) and the status it is accorded (evaluation). Our analysis suggests that participatory policy processes do not represent the simple task of assessing the quality/effectiveness of a given technology against self-evident criteria. Rather, these processes involve the negotiation of different orders of evidence (empirical, contextual and anecdotal), indicating a need for higher-level discussion around 'what counts and how to count it' when making disinvestment decisions.
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Previous studies have described that support, especially from clinical leaders and the general public, is essential for the success of the disinvestment process.
“support, especially from clinical leaders, but from the general public as well, was found to be essential for the success of the disinvestment process [6, 33, 34].”
From What influences the outcome of active disinvestment processes in healthcare? A qualitative interview study on five recent cases of active disinvestment (2021) · cites this paper as [33]
The Conclusion (page not provided) says physicians have a pivotal role in implementing policy outcomes and that facilitating their buy-in is important. The Introduction links community participation to policy legitimacy and public ownership, but the paper does not say that support from clinical leaders specifically, or from the general public, is essential for successful disinvestment. (LLM, conf=0.86)
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Research works printed but not linked: 13
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Towards understanding the de-adoption of low-value clinical practices: a scoping review
Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015) · BMC Medicine · doi:10.1186/s12916-015-0488-z · Cited by 369 · see citing works
Rotteveel, A. H., Lambooij, M. S., van de Rijt, J. J. A., van Exel, J., Moons, K. G. M., & de Wit, G. A. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06298-3 · Cited by 16 · see citing works
- Authors
- Hodgetts, K., Elshaug, A. G., & Hiller, J. E.
- Affiliations
- The University of Adelaide (AU)
- Harvard University (US)
- Corresponding author
- Hiller, Janet E.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 75
- Issue
- 12
- Pages
- 2191-2199
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W1994840764
- Cited by
- 27
- References
- 0
- Citations by year
- 2023: 2 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 3 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Social Science & Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- National Health and Medical Research Council of Australia (565327)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Physiology › Biomedical Ethics and Regulation
- Keywords
- assisted reproduction, older women, divestiture, evidence construction, physicians, participatory policymaking, evidence evaluation, health policy
- MeSH terms
- Australia, Female, Health Policy, Humans, Male, National Health Programs, Physicians, Evidence-Based Medicine, Reproductive Techniques, Assisted
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