Abstract
BackgroundCurrent healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process.DiscussionWe contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence.SummaryIn this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved.
Highlights
Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process
We identify some of the biases and potential intervention points and provide some initial suggestions about how the evidence-based decision making (EBDM)/evidencebased policy making (EBPM) process can be improved
While competing influences on decision making are not new topics, the recent emphasis in public policy on evidence-based decision making (EBDM) and evidencebased policy making (EBPM) reinforces the need to examine some of the factors that bias the decision-making process
Summary
EBDM: The challenges of rational choice Numerous healthcare systems exist globally, yet many of the same factors influence the direction of health policy regardless of national boundaries. Cognitive heuristics serve as a trigger to a prototypical representation of a situation/decision, thereby creating a judgment or response based on memory bin representations from previous experiences rather than a judgment based on the evidence of the current situation [9,10] This linkage of decision-making heuristics to experiences during cognitive information processing supports the following proposition: Proposition 3: Policy makers who are presented with cognitively difficult policy information and who have available in their memory a relevant heuristic will utilize that specific cognitive shortcut to support the presented policy, while those individuals who do not have an available relevant cognitive heuristic will be less likely to use a heuristic in support of the presented policy. One must be mindful that cognitive shortcuts do not ensure that the final decision best resolves a problem, and cognitive shortcutting fails to follow the expectations of EBDM [66]
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