The Politics of Evidence Use in Health Policy Making in Germany—the Case of Regulating Hospital Minimum Volumes

This article examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Fede...

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Bibliographic Details
Published in:Journal of health politics, policy and law policy and law, 2017-06, Vol.42 (3), p.513-538
Main Author: Ettelt, Stefanie
Format: Article
Language:English
Subjects:
Clinical outcomes
Committees
Corporatism
Correlation analysis
Court decisions
Courts
Decision analysis
Decision makers
Decision making
Decision Making - ethics
Federal legislation
Germany
Health
Health care policy
Health Policy
Hospitals
Hospitals, High-Volume
Humans
Judiciary
Legislation
Medical decision making
Medicine and Health
Patients
Policy implementation
Policy Making
Political Science
Politics
Public Health - legislation & jurisprudence
Public Health and Health Policy
Public Policy
Regulation
Scientific evidence
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Summary:This article examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Federal Joint Committee as the regulator. Minimum volumes regulation was inspired by scientific evidence suggesting a positive relationship between service volume and patient outcomes for complex surgical interventions. Federal legislation was introduced in 2002 to delegate the selection of services and the setting of volumes to corporatist decision makers. Yet, despite being represented in the Federal Joint Committee, hospitals affected by its decisions took the Committee to court to seek legal redress and prevent policy implementation. Evidence has been key to support, and challenge, decisions about minimum volumes, including in court. The analysis of the role of scientific evidence in minimum volumes regulation in Germany highlights the dynamic relationship between evidence use and the political and institutional context of health policy making, which in this case is characterized by the legislative nature of policy making, corporatism, and the role of the judiciary in reviewing policy decisions.
ISSN:0361-6878
1527-1927
DOI:10.1215/03616878-3802965