Graduate Program in Health, York University, Toronto, Canada.
BMC Health Serv Res. 2013 Mar 9;13:88. doi: 10.1186/1472-6963-13-88.
Pressures on health care budgets have led policy makers to discuss how to balance the provision of costly technologies to populations in need and making coverage decisions under uncertainty. Coverage with evidence development (CED) is being employed to meet these challenges.
Twenty-four interviews were carried out between June 2009 and December 2010 with researchers, decision makers and policy makers from Australia, Canada, United Kingdom and United States. Three phases of coding occurred, the first being manual coding where the interviews were read and notes were taken and nodes were extracted and imputed. NVIVO coding was applied to the interview transcripts, with both broad general searches for word usages and imputed nodes.
Four overarching thematic areas emerged out of contextual analysis of the interviews - (1) what constitutes CED; (2) the lack of a systematic approach/governance structure; (3) the role of the pharmaceutical industry and overt political considerations in CED; and (4) alternatives and barriers to CED. We explore these themes and then use concrete examples of CED projects in each of the four countries to illustrate the political issues that our interviewees raised.
Until the underlying political nature of CED is recognized then fundamental questions about its usefulness and operation will remain unresolved.
医疗保健预算的压力促使政策制定者讨论如何在为有需要的人群提供昂贵技术和在不确定的情况下做出覆盖决策之间取得平衡。证据开发覆盖（CED）正在被用来应对这些挑战。
2009 年 6 月至 2010 年 12 月期间，与来自澳大利亚、加拿大、英国和美国的研究人员、决策者和政策制定者进行了 24 次访谈。进行了三个阶段的编码，第一阶段是手动编码，阅读访谈并记录笔记，提取和推断节点。对访谈记录进行了 NVIVO 编码，同时进行了广泛的通用词汇搜索和推断节点搜索。
通过对访谈的语境分析，出现了四个总体主题领域 - (1) CED 的构成；(2) 缺乏系统的方法/治理结构；(3) 制药行业和 CED 中明显的政治考虑因素的作用；以及 (4) CED 的替代方案和障碍。我们探讨了这些主题，然后使用来自四个国家的 CED 项目的具体例子来说明我们的受访者提出的政治问题。
除非认识到 CED 的潜在政治性质，否则关于其有用性和运作的基本问题将仍然没有得到解决。
