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Rationality versus reality: the challenges of evidence-based decision making for health policy makers

Overview
Title:
Rationality versus reality: the challenges of evidence-based decision making for health policy makers
Authors:
McCaughey D, Bruning NS
Journal:
Implement Sci.
Publication date:
2010
Volume:
5
Issue:
1
First page:
39
Link to full text:
http://www.implementationscience.com/content/5/1/39
Publication type:
Journal
Abstract
Background Current health care systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, health care funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. The nature of 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. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) 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. 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. Summary In this era of increasing adoption of evidence-based health care models, the rational choice, utility maximizing assumptions in EBDM, must be evaluated to ensure effective and high quality health policy decisions. The cognitive information processing framework 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 process can be improved.
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Rationality versus reality: the challenges of evidence-based decision making for health policy makers McCaughey D, Bruning NS. Implement Sci. 2010; 5(1):39.

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