On Fundamental Premises for Addressing "Context" and "Contextual Factors" Influencing Value Decisions in Healthcare Comment on "Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis"

Bærøe, Kristine

doi:10.15171/ijhpm.2018.62

Cited by 2 publications

(4 citation statements)

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“…As Bærøe noted, 17 there is a difference between approaches aiming to formulate a comprehensive list, and those that would hold that this is impossible. Although we have chosen a limited list as it facilitates this research, we do not necessarily believe that an exhaustive list would be possible.…”

Section: Discussionmentioning

confidence: 99%

“…3,[10][11][12][13][14][15][16] What this umbrella of contextual factors holds exactly has recently attracted scholarly interest for 'decisions of value' in the healthcare field. [17][18][19][20] Williams et al initiated the discussion with a literature review focused on meso-level decisionmaking, exploring both 'inner' and 'outer' contexts and how these may affect such decisions of value. 14 Many of the papers reviewed by Williams et al give 'context' as a relatively abstract explanation, and as something that is not necessarily visible in the final decision document.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, we will term contexts that are present in the final decision documentation, which provides a justification, or rationale, for the decision, ‘contextual factors.’ In this, we narrow down and specify Williams et al’s original description of contextual factors. 17 Of the contexts retrieved from literature by Williams et al, only 2 may be considered situation-specific, namely first, the information accessed by the decision-makers, or its absence, and especially high levels of uncertainty regarding this information; and second, the presence of specific interests impacting the decision. That the technology and its information would vary per decision may be considered logical; the latter finding resonates with situation-specific contexts identified elsewhere for macro-level coverage decisions.…”

Section: Introductionmentioning

confidence: 99%

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Around the Tables – Contextual Factors in Healthcare Coverage Decisions Across Western Europe

Kleinhout-Vliek

Bont

Boysen

et al. 2020

Int J Health Policy Manag

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Background: Across Western Europe, procedures and formalised criteria for taking decisions on the coverage (inclusion in the benefits basket or equivalent) of healthcare technologies vary substantially. In the decision documents, which display the justification of, the rationale for, these decisions, national healthcare institutes may employ ‘contextual factors,’ defined here as situation-specific considerations. Little is known about how the use of such contextual factors compares across countries. We describe and compare contextual factors as used in coverage decisions generally and 4 decision documents specifically in Belgium, England, Germany, and the Netherlands. Methods: Four group interviews with 3 experts from the national healthcare institute of each country, document and web site analysis, and a workshop with 1 to 2 of these experts per country were followed by the examination of the documents of 4 specific decisions taken in each of the 4 countries, sampled to vary widely in type of technology and decision outcome. Results: From the available decision documents, we conclude that in every country studied, contextual factors are established ‘around the table,’ ie, in deliberation. All documents examined feature contextual factors, with similar contextual factor patterns leading to similar decisions in different countries. The Dutch decisions employ the widest variety of factors, with the exception of the societal functioning of the patient, which is relatively common in Belgium, England, and Germany. Half of the final decisions were taken in another setting, with the consequence that no documentation was retrievable for 2 decisions. Conclusion: First, we conclude that in these countries, contextual factors are actively integrated in the decision document, and that this is achieved in deliberation. Conceptualising contextual factors as both situation-specific and actively-integrated affords insight into practices of contextualisation and provides an encouragement for exchange between decision-makers on more qualitative aspects of decisions. Second, the decisions that lacked a publicly accessible justification of the final decision document raised questions on the decisions’ legitimacy. Further research could address patterning of contextual factors, elucidate why some factors may remain implicit, and how decisions without a publicly available decision document may enable or restrain decision-making practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Around the Tables – Contextual Factors in Healthcare Coverage Decisions Across Western Europe

Kleinhout-Vliek

Bont

Boysen

et al. 2020

Int J Health Policy Manag

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show abstract

“…They argue for deliberative approaches and again we agree. Distinctions between ‘formal’ and ‘arbitrary’ influencers, 4 and between front and backstage decision making, 5 are extremely useful for research in this field and we will incorporate them in future. We support Michael Calnan’s call for ethnographic observation in this research area, and indeed our own work on the use by NICE of economic evaluation appears to support his conclusions.…”

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confidence: 99%