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Questions regarding ‘epistemic injustice’ in knowledge-intensive policymaking: Two examples from Dutch health insurance policy

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  • Moes, Floortje
  • Houwaart, Eddy
  • Delnoij, Diana
  • Horstman, Klasien

Abstract

In contemporary healthcare policies the logic of Evidence-based Medicine (EBM) is typically proposed as a way of addressing a demand to explicitly justify policy decisions. Policymakers' use of ‘evidence’ is presumed to pertain to ideals of justice in decision-making. However, according to some, EBM is liable to generate ‘epistemic injustice’ because it prefers quantitative types of evidence and – as a result of that – potentially undervalues the qualitative testimonies of doctors and patients. Miranda Fricker's concept of ‘epistemic injustice’ refers to a wrong done to a person in their capacity as a knower. This paper explores the usefulness and limits of this concept in the context of public decision-making. How is evidence-based policymaking intertwined with questions of ‘epistemic injustice’? Drawing from ethnographic research conducted at the National Health Care Institute, we analyze two cases of EBM-inspired policy practices in Dutch social health insurance: 1) the use of the principles of EBM in making a public reimbursement decision, and 2) private insurers' use of quantitative performance indicators for the practice of selective contracting on the Dutch healthcare market. While the concept of ‘epistemic injustice’ misses some key processes involved in understanding how ‘knowing gets done’ in public policy, it does shed new light on priority-setting processes. Patients or medical professionals who are not duly recognized as credible and intelligible epistemic agents, subsequently, lack the social power to influence priority-setting practices. They are thus not merely frustrated in their capacity to be heard and make themselves understood, they are potentially deprived of a fair share in collective financial and medical resources. If we fail to recognize inequalities in credibility and intelligibility between diverse groups of knowers, there is a chance that these epistemic inequalities are being reproduced in our system of health insurance and our ways of distributing healthcare provisions.

Suggested Citation

  • Moes, Floortje & Houwaart, Eddy & Delnoij, Diana & Horstman, Klasien, 2020. "Questions regarding ‘epistemic injustice’ in knowledge-intensive policymaking: Two examples from Dutch health insurance policy," Social Science & Medicine, Elsevier, vol. 245(C).
    • Handle: RePEc:eee:socmed:v:245:y:2020:i:c:s0277953619306690
    DOI: 10.1016/j.socscimed.2019.112674
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    References listed on IDEAS

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    1. Wynand P. M. M. Van de Ven & Frederik T. Schut, 2009. "Managed competition in the Netherlands: still work‐in‐progress," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 253-255, March.
    2. Mykhalovskiy, Eric & Weir, Lorna, 2004. "The problem of evidence-based medicine: directions for social science," Social Science & Medicine, Elsevier, vol. 59(5), pages 1059-1069, September.
    3. Boone, Jan & Zwart, Gijsbert, 2009. "Selective contracting and foreclosure in health care markets," CEPR Discussion Papers 7576, C.E.P.R. Discussion Papers.
    4. Moes, Floortje & Houwaart, Eddy & Delnoij, Diana & Horstman, Klasien, 2017. "Contested evidence: a Dutch reimbursement decision taken to court," Health Economics, Policy and Law, Cambridge University Press, vol. 12(3), pages 325-344, July.
    5. Deaton, Angus & Cartwright, Nancy, 2018. "Understanding and misunderstanding randomized controlled trials," Social Science & Medicine, Elsevier, vol. 210(C), pages 2-21.
    6. Moes, Floortje & Houwaart, Eddy & Delnoij, Diana & Horstman, Klasien, 2017. "Contested evidence: a Dutch reimbursement decision taken to court – CORRIGENDUM," Health Economics, Policy and Law, Cambridge University Press, vol. 12(3), pages 401-401, July.
    7. Robert Hoppe, 1999. "Policy analysis, science and politics: from ‘speaking truth to power’ to ‘making sense together’," Science and Public Policy, Oxford University Press, vol. 26(3), pages 201-210, June.
    8. 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.
    9. Lambert, Helen, 2006. "Accounting for EBM: Notions of evidence in medicine," Social Science & Medicine, Elsevier, vol. 62(11), pages 2633-2645, June.
    10. Peter Weingart, 1999. "Scientific expertise and political accountability: paradoxes of science in politics," Science and Public Policy, Oxford University Press, vol. 26(3), pages 151-161, June.
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