The evidence-based approach in health policy and health care delivery
Introduction
Evidence-based approaches in health can be described as health policy and health care delivery driven by systematically collected proof on the effects of health-related interventions from the social and health sciences. During the 1990s, evidence-based approaches have become prominent on the national and international agendas for health policy and health research. Yet, it is unclear what the implications of this rational approach are for the production and distribution of health in populations, given the notion of multiple determinants of health. It is equally unclear what kinds of barriers there are to the adoption of evidence-based approaches in health care practice. Depending on political vision, breadth of causal thinking, and the amount of accumulated evidence on the causes of ill health, health policy addresses health issues at different levels of impact. First, this paper will sketch general developments in the way in which health policy is informed by the results from health research. Next, the paper summarises evidence-based approaches in health at three impact levels: intersectoral assessment, national health care policy, and evidence-based medicine in everyday practice.
Section snippets
Informed health policy
Health policy in the broadest sense can be defined as those actions of governments and other actors in society that are aimed at improving the health of populations. Ideally, there would be a cycle of policy formulation, implementation, and assessment. In the assessment of policy outcomes, scientific evidence should play an important role (MOH, 1986, Ruwaard, 1994, Tugwell et al., 1985, US Congress, O. o. T. A., 1994, McGinnis and Lee, 1995). Over the past two decades, national and
Intersectoral assessment
National health status documents recognise the role of multiple determinants of health. It includes the influences of other societal sectors of governmental concern. Research, however, is still scarce. Some econometric research deals with entangling the relationship between economic development, or health care development, and mortality change at the national level (Pritchett and Summers, 1997, Kwakani, 1993, Preston, 1975, Mackenbach, 1988, McGuire et al., 1993). In these kinds of studies, one
Evidence-based health care policy
Several objectives of health care policy are mentioned in policy documents as universal access, comprehensive and uniform benefits, equitable financing, value for money, public accountability and freedom of choice by consumers and providers (Daniels, Light & Caplan, 1996). When attempting to support health policy, it is important to understand how these objectives can be defined, operationalised and measured. This is by no means straightforward. At the start of an EC-funded programme on equity
Evidence-based medicine in practice
Clinical guidelines can be defined as systematically developed statements to assist clinicians and patient’s decisions about appropriate health care in specific clinical circumstances. If evidence-based, they may contribute to further defining and improving the quality of health care delivery (Sackett, Rosenberg, Gray, Haynes & Richardson, 1996) and enhance population health (Field and Lohr, 1990, Burnand, 1999). They may promote resource efficiency by identifying sources of inappropriate use
Conclusion: the near future of evidence-based health policy
Consensus is growing on the role of broad and specific health determinants, including health care, as well as on priority setting based on the burden of diseases and the opportunities to reduce such burden in a cost-effective way. There will be a demand for intersectoral assessments, in spite of methodological constraints, especially in the area of health sector reform. Initiators of policy changes in other sectors might be held responsible for providing the evidence related to health. Due to
Acknowledgements
We thank Ken Redekop, Chris de Laet and the unknown referee for their comments on the manuscript. The Institute for Medical Technology Assessment is conducting a programme on the economic evaluation of Dutch medical guidelines, funded by the Ministry of Health.
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