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What is evidence-based health policy?

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As the debate over health policy continues, both anecdotal and study-related arguments are often used to try to determine the best path for healthcare reform. Two health economists, writing in The New England Journal of Medicine, make the case for evaluating health policy alternatives based on consistently solid and well-defined evidence.

In their article, Evidence-Based Health Policy, Katherine Baicker, Ph.D., and Amitabh Chandra, Ph.D. write that “Having a clear framework for characterizing what is, and isn’t, evidence-based health policy (EBHP) is a prerequisite for a rational approach to making policy choices, and it may even help focus the debate on the most promising approaches.”

The authors indicate that EBHP has “three essential characteristics”:

Policies need to be well-specified; a slogan is not sufficient. The authors explain that “’target population health’ doesn’t qualify as a policy, let alone EBHP.” Policies must contain specifics in regard to what will be done, who will benefit, and how it will be done, enabling policy makers to assess “the relative effectiveness and implementation details.”

Implementing EBHP requires us to distinguish between policies and goals. Policies are designed to help physicians and other healthcare providers achieve goals. Often there is more than goal involved in a policy and within that, one goal might be more achievable than the others. The authors cite the example of “claims that care coordination ‘doesn’t work’ because it doesn’t save money miss the point that it may achieve other goals.”

EBHP requires evidence of the magnitude of the effects of the policy, and obtaining such evidence is an inherently empirical endeavor. The economists emphasize that “introspection and theory are terrible ways to evaluate policy.” Even clear conceptual models that indicate what a specific impact of a policy may be do not always show the level of that impact. They add that “often even the direction of the effect is unclear without empirical research, with different effects potentially going in opposite directions.”

Evidence-Based Health Policy concludes that “Just because something sounds true doesn’t mean that it is, and magical thinking won’t improve our health care system. EBHP helps separate facts from aspiration.”