Orosz E
Institute of Sociology & Social Policy of Eötvös Loránd University, Budapest, Hungary.
Soc Sci Med. 1994 Nov;39(9):1287-93. doi: 10.1016/0277-9536(94)90360-3.
The relationship between research and health policy is discussed from a policy process perspective, describing communication problems in the course of policy formulation, implementation and evaluation. Policy process is often expected by researchers to be rational, having logical sequence of steps and the objective evaluation of alternatives based on scientific knowledge. In fact, policies are often formulated without clear problem identification or based on wrong assumption. The timing of research and policy-making differs. Policy-makers need to respond quickly. Evaluations may be regarded by politicians as embarrassing if they point to a need for significant change. It is not satisfactory to consider only research and policy-making: their relationship is influenced by the media, different interest groups and by the general public. Health policy formulation is embedded in the general policy environment of particular societies. Some countries have a long tradition of consensus-building, while in others health reforms have been formulated and introduced in a centralized way. Traditional bio-medical thinking influences health policy-makers. The importance of social and political acceptability tends to be overlooked. The paper emphasizes that we are experiencing an era of scarcity of resources and growing tension concerning allocation decisions. Existing institutions provide insufficient incentives for policy-makers and researchers to promote public dialogue about such issues. The paper concludes that there is a need for new approaches to policy development and implementation, new structures in policy-making, changes in research financing and co-operation between disciplines and new structures for public participation in policy-making. Research should facilitate more open and democratic dialogue about policy options and the consequences of alternative choices.
本文从政策过程的角度探讨了研究与卫生政策之间的关系，描述了政策制定、实施和评估过程中的沟通问题。研究人员通常期望政策过程是理性的，具有合乎逻辑的步骤顺序，并基于科学知识对各种选择进行客观评估。事实上，政策制定往往没有明确识别问题或基于错误的假设。研究与政策制定的时间安排不同。政策制定者需要迅速做出回应。如果评估指出需要进行重大变革，政治家们可能会认为这些评估令人尴尬。仅考虑研究和政策制定是不够的：它们之间的关系受到媒体、不同利益集团和公众的影响。卫生政策制定嵌入在特定社会的总体政策环境中。一些国家有长期的建立共识的传统，而在其他国家，卫生改革是以集中的方式制定和推行的。传统的生物医学思维影响着卫生政策制定者。社会和政治可接受性的重要性往往被忽视。本文强调，我们正处于一个资源稀缺且关于分配决策的紧张局势不断加剧的时代。现有的制度为政策制定者和研究人员促进关于此类问题的公众对话提供的激励不足。本文得出结论，需要新的政策制定和实施方法、新的政策制定结构、研究资金的变化以及学科间的合作，以及新的公众参与政策制定的结构。研究应促进就政策选择及其替代选择的后果进行更开放和民主的对话。
