Public Health Public Policy

What is evidence-based health policy?

Many people have heard of evidence-based medicine (EBM).  A perspective piece in the New England Journal of Medicine by Katherine Baicker and Amitabh Chandra, however, tries to define what evidence-based health policy (EBHP) is.  They list three key criteria:

  • Policies need to be well-specified.  For instance, “expand Medicaid coverage” is too general, whereas specifying that benefit package A be extended to population B at cost C, is getting to more of the specifics needed.
  • EBHP represent policies, not goals.  The same exact value-based purchasing program, for instance, could have multiple goals, (e.g., reducing cost, improving quality).  The policy itself is what is being evaluated, whereas the goals depend on the evaluator’s perspective.
  •  EBHP requires evidence of the magnitude of the effects of the policy.  Empirical evidence is needed to show a specific health policy works.  Further, just showing a statistically significant result is not enough, it also must be of sufficient magnitude to be relevant to stakeholders, especially when compared against other policy interventions.

In addition, the authors argue that the perfect should not be the enemy of the good. That is my interpretation of the authors saying that “In health policy — as in any other realm — it is often necessary to act on the basis of the best evidence on hand, even when that evidence is not strong. Doing so requires weighing the costs of acting when you shouldn’t against those of not acting when you should — again, a matter of policy priorities.”

Conducting health policy research is complex not only due to the empirical complications, but also because policy goals and priorities vary across stakeholders and empirical evidence of the effect of health policies may or may not resolve this debate.  Nevertheless, by using evidence-based approaches to identify the effect of health policies, society can make these policies decisions knowing full well the implications of their decisions.

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