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What counts and how to count it: Physicians’ constructions of evidence in a disinvestment context


  • Hodgetts, Katherine
  • Elshaug, Adam G.
  • Hiller, Janet E.


Internationally, there is an increasing focus on quality and sustainability measures oriented to reducing inefficiencies in health provision. The use of assisted reproductive technologies (ART) for older women represents a case study in this area. This paper analyses the constructions of evidence brought to bear by ART physicians in the context of deliberative stakeholder engagements (held 2010) around options for restricting public subsidy of ART in Australia. Physicians participated in two deliberative engagements during which they were presented with results of a systematic review of ART effectiveness, as well as ethical and cost analyses. These sessions were part of a broader research program of engagements held with policymakers, community members and consumers. Physicians deliberated around the data presented with a view to formulating an informed contribution to policy. The ensuing discussions were transcribed and subject to discourse analysis. Physicians questioned the evidence presented on the grounds of ‘currency’, ‘proximity’, ‘selectivity’ and ‘bias’. We outline physicians’ accounts of what should count as evidence informing ART policy, and how this evidence should be counted. These accounts reflect implicit decisions around both the inclusion of evidence (selection) and the status it is accorded (evaluation). Our analysis suggests that participatory policy processes do not represent the simple task of assessing the quality/effectiveness of a given technology against self-evident criteria. Rather, these processes involve the negotiation of different orders of evidence (empirical, contextual and anecdotal), indicating a need for higher-level discussion around ‘what counts and how to count it’ when making disinvestment decisions.

Suggested Citation

  • Hodgetts, Katherine & Elshaug, Adam G. & Hiller, Janet E., 2012. "What counts and how to count it: Physicians’ constructions of evidence in a disinvestment context," Social Science & Medicine, Elsevier, vol. 75(12), pages 2191-2199.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:12:p:2191-2199
    DOI: 10.1016/j.socscimed.2012.08.016

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    References listed on IDEAS

    1. Devlin, N., 2003. "Does NICE have a cost effectiveness threshold and what other factors influence its decisions? A discrete choice analysis," Working Papers 03/01, Department of Economics, City University London.
    2. Nancy Devlin & David Parkin, 2004. "Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 437-452.
    3. Abelson, Julia & Giacomini, Mita & Lehoux, Pascale & Gauvin, Francois-Pierre, 2007. "Bringing `the public' into health technology assessment and coverage policy decisions: From principles to practice," Health Policy, Elsevier, vol. 82(1), pages 37-50, June.
    4. Carolyn M. Hendriks & John S. Dryzek & Christian Hunold, 2007. "Turning Up the Heat: Partisanship in Deliberative Innovation," Political Studies, Political Studies Association, vol. 55, pages 362-383, June.
    5. Watt, Amber M. & Elshaug, Adam G. & Willis, Cameron D. & Hiller, Janet E., 2011. "Assisted reproductive technologies: A systematic review of safety and effectiveness to inform disinvestment policy," Health Policy, Elsevier, vol. 102(2), pages 200-213.
    6. Duthie, Tessa & Trueman, Paul & Chancellor, Jeremy & Diez, Lara, 1999. "Research into the use of health economics in decision making in the United Kingdom--Phase II: Is health economics `for good or evil'?," Health Policy, Elsevier, vol. 46(2), pages 143-157, January.
    7. Mitton, Craig & Patten, San & Waldner, Howard & Donaldson, Cam, 2003. "Priority setting in health authorities: a novel approach to a historical activity," Social Science & Medicine, Elsevier, vol. 57(9), pages 1653-1663, November.
    8. Williams, Iestyn P. & Bryan, Stirling, 2007. "Cost-effectiveness analysis and formulary decision making in England: Findings from research," Social Science & Medicine, Elsevier, vol. 65(10), pages 2116-2129, November.
    9. Dobrow, Mark J. & Goel, Vivek & Upshur, R. E. G., 2004. "Evidence-based health policy: context and utilisation," Social Science & Medicine, Elsevier, vol. 58(1), pages 207-217, January.
    10. Tritter, Jonathan Quetzal & McCallum, Alison, 2006. "The snakes and ladders of user involvement: Moving beyond Arnstein," Health Policy, Elsevier, vol. 76(2), pages 156-168, April.
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    Cited by:

    1. Rooshenas, Leila & Owen-Smith, Amanda & Hollingworth, William & Badrinath, Padmanabhan & Beynon, Claire & Donovan, Jenny L., 2015. "“I won't call it rationing…”: An ethnographic study of healthcare disinvestment in theory and practice," Social Science & Medicine, Elsevier, vol. 128(C), pages 273-281.


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