The quality and use of knowledge in health policy-making: a case study

Abstract

A decision-making process about a healthcare programme is examined. The main objective of the programme was to reduce the high levels of risk factors for diseases such as coronary heart disease in individuals that conventional medical care could not handle well. The programme was ended after 10 years of operation. Why was this programme stopped and not another? Was the decision to end based on unsatisfactory performance of the programme and/or that there were better alternative uses of the resources? To answer the questions three models of decision-making will be applied to the process; special attention will be paid to the nature of knowledge on which the decision was based as well as to the logic of the process itself. The knowledge component of the process was deficient in a number of ways; nevertheless no other information was asked for by the participants. The role of the main body of the politicians in the decision-making process was extremely small. There were no traces of political ideology or a rational policy-making framework informing the decision; in fact the process was governed more by the enigmatic views of the political leadership and/or of the administrative leadership. To conclude, there is discussion of the implications of the results, especially whether the standard of knowledge, as well as the want of a systemic approach to health policy, was an aberration or reflected more common decision-making practices.