Sandberg Johanna, Persson Bo, Garpenby Peter
Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Division of Political Science, Department of Management and Engineering, Linköping University, Linköping, Sweden.
Health Econ Policy Law. 2019 Oct;14(4):425-442. doi: 10.1017/S1744133118000233. Epub 2018 Jul 10.
There is a growing recognition of the importance of evidence to support allocative policy decisions in health care. This study is based on interviews with politicians in four regional health authorities in Sweden. Drawing on theories of strategic use of knowledge, the article analyses how politicians perceive and make use of expert knowledge represented by the National Guidelines, embracing both a scientific and a political rationale. As health care is an organisation with a dual basis for legitimacy - at the same time a political and an action organisation - it affects knowledge use. We investigate how the context of health care priority setting influences the conditions for knowledge use among regional politicians. Our findings illustrate the dilemma of political decision-makers and how they prefer to use expert knowledge. The politicians use this policy instrument in a legitimising fashion, as it will fit into the current political debate on more equal care. As an instrument for resource allocation the politicians noted that 'facts' per se could not provide them with a sufficient basis for legitimising their governing of health care. The dualistic organisational context makes knowledge important as a political weapon in negotiations with the medical profession.
人们越来越认识到证据对于支持医疗保健领域资源分配政策决策的重要性。本研究基于对瑞典四个地区卫生当局的政治家的访谈。借鉴知识战略运用理论，本文分析了政治家如何看待和利用由国家指南所代表的专家知识，其中既包含科学依据，也包含政治依据。由于医疗保健是一个具有双重合法性基础的组织——既是政治组织又是行动组织——这会影响知识的运用。我们调查了医疗保健优先事项设定的背景如何影响地区政治家知识运用的条件。我们的研究结果揭示了政治决策者的困境以及他们倾向于如何使用专家知识。政治家以一种使其合法化的方式使用这一政策工具，因为它符合当前关于更平等医疗保健的政治辩论。作为一种资源分配工具，政治家指出，“事实”本身并不能为他们治理医疗保健提供足够的合法化依据。二元化的组织背景使知识在与医疗行业的谈判中成为一种重要的政治武器。
