Decisions of Value: Going Backstage Comment on "Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis".

Michael Calnan

doi:10.15171/ijhpm.2018.81

Abstract

This commentary expands on two of the key themes briefly raised in the paper involving analysis of the evidence about key contextual influences on decisions of value. The first theme focuses on the need to explore in more detail what is called backstage decision-making looking at how actual decisions are made drawing on evidence from ethnographies about decision-making. These studies point to less of an emphasis on instrumental and calculative forms of decision-making with more of an emphasis on more pragmatic rationality. The second related theme picks up on the issue of sources of information as a contextual influence particularly highlighting the salience of uncertainty or information deficits. It is argued that there are a range of different types of uncertainties, not only associated with information deficits, which are found particularly in allocative types of decisions of value. This means that the decision-making process although attempting to be linear and rational, tends to be characterised by a form of navigation where the decision-makers navigate their way through the uncertainties inherent and overtly manifested in the decision-making process.

Highlights

The importance of understanding the contextual influences on decision-making about cost and quality related questions in the organisation and provision of healthcare is well recognised.[1]
Research focusing at the national level involving the ‘fourth’ stage of medicine regulation and which has explored decision-making by the National Institute for Health and Care Excellence (NICE) about the appraisal of expensive medicines has identified the difference between front stage and backstage decision-making
The discourse associated with front stage decision-making emphasises the dominant influence of the technical criteria of costeffectiveness in some cases social values tended to receive some explicit recognition in the decision-making such as in the treatment for younger children

Summary

Introduction

The importance of understanding the contextual influences on decision-making about cost and quality related questions in the organisation and provision of healthcare is well recognised.[1].

Results

Conclusion