On Fundamental Premises for Addressing "Context" and "Contextual Factors" Influencing Value Decisions in Healthcare Comment on "Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis".

Kristine Bærøe

doi:10.15171/ijhpm.2018.62

Abstract

In this commentary on Williams and colleagues’ paper, I will address some essential issues related to research on contextual factors that influence value decision-making in healthcare. Based on the presumption that scientific work requires coherence in its ontological, epistemological and methodological approaches, I identify some challenges in their text and reflect on how those challenges might be addressed. I recommend that more normative work be done to make this a comprehensive area of research and suggest that the fundamental premises structuring investigations in this field be explicitly clarified.

Highlights

In their literature review on contextual factors that influence cost and quality decisions in healthcare, Williams, Brown and Healy synthesise evidence on factors that affect allocative and technical meso-level decisions.[1]
I welcome this attention to contextual factors and to how they may influence cost and quality decision-making in healthcare
I value the efforts the authors have made in examining the literature and their attentiveness to technical decisions; these are important priority- and limitsetting decisions, they occur less conspicuously than allocative decisions

Summary

Introduction

In their literature review on contextual factors that influence cost and quality decisions in healthcare, Williams, Brown and Healy synthesise evidence on factors that affect allocative and technical meso-level decisions.[1]. The Relation Between Normative Ideals and Descriptive Findings The first challenge relates to how the authors perceive the relationship between identified contextual influencing factors and what should be done in light of them.

Results

Conclusion