IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v245y2020ics0277953619306690.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953619306690
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2019.112674?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. 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.
    2. Bijlsma, M. & Boone, J. & Zwart, Gijsbert, 2009. "Selective Contracting and Foreclosure in Health Care Markets," Other publications TiSEM fee69eb7-1661-4ec2-8aae-f, Tilburg University, School of Economics and Management.
    3. Deaton, Angus & Cartwright, Nancy, 2018. "Understanding and misunderstanding randomized controlled trials," Social Science & Medicine, Elsevier, vol. 210(C), pages 2-21.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Perrotta, Manuela & Geampana, Alina, 2020. "The trouble with IVF and randomised control trials: Professional legitimation narratives on time-lapse imaging and evidence-informed care," Social Science & Medicine, Elsevier, vol. 258(C).
    2. Timmermans, Stefan & Almeling, Rene, 2009. "Objectification, standardization, and commodification in health care: A conceptual readjustment," Social Science & Medicine, Elsevier, vol. 69(1), pages 21-27, July.
    3. Taipale, Jaakko & Hautamäki, Lotta, 2021. "Clinical practice guidelines in courts’ representation of medical evidence and testimony," Social Science & Medicine, Elsevier, vol. 275(C).
    4. Broom, Alex & Adams, Jon & Tovey, Philip, 2009. "Evidence-based healthcare in practice: A study of clinician resistance, professional de-skilling, and inter-specialty differentiation in oncology," Social Science & Medicine, Elsevier, vol. 68(1), pages 192-200, January.
    5. Behague, Dominique & Tawiah, Charlotte & Rosato, Mikey & Some, Télésphore & Morrison, Joanna, 2009. "Evidence-based policy-making: The implications of globally-applicable research for context-specific problem-solving in developing countries," Social Science & Medicine, Elsevier, vol. 69(10), pages 1539-1546, November.
    6. Rhodes, Tim & Lancaster, Kari, 2019. "Evidence-making interventions in health: A conceptual framing," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    7. Blume, Stuart & Tump, Janneke, 2010. "Evidence and policymaking: The introduction of MMR vaccine in the Netherlands," Social Science & Medicine, Elsevier, vol. 71(6), pages 1049-1055, September.
    8. Bauer, Anja & Kastenhofer, Karen, 2019. "Policy advice in technology assessment: Shifting roles, principles and boundaries," Technological Forecasting and Social Change, Elsevier, vol. 139(C), pages 32-41.
    9. Lambert, Helen, 2006. "Accounting for EBM: Notions of evidence in medicine," Social Science & Medicine, Elsevier, vol. 62(11), pages 2633-2645, June.
    10. Teghtsoonian, Katherine, 2009. "Depression and mental health in neoliberal times: A critical analysis of policy and discourse," Social Science & Medicine, Elsevier, vol. 69(1), pages 28-35, July.
    11. Diamond-Brown, Lauren, 2018. "“It can be challenging, it can be scary, it can be gratifying”: Obstetricians’ narratives of negotiating patient choice, clinical experience, and standards of care in decision-making," Social Science & Medicine, Elsevier, vol. 205(C), pages 48-54.
    12. Baeza, Juan I. & Boaz, Annette & Fraser, Alec, 2016. "The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland," Social Science & Medicine, Elsevier, vol. 155(C), pages 15-23.
    13. Christopher J. Ruhm, 2019. "Shackling the Identification Police?," Southern Economic Journal, John Wiley & Sons, vol. 85(4), pages 1016-1026, April.
    14. Kate Dooley & Aarti Gupta, 2017. "Governing by expertise: the contested politics of (accounting for) land-based mitigation in a new climate agreement," International Environmental Agreements: Politics, Law and Economics, Springer, vol. 17(4), pages 483-500, August.
    15. Martin, Will, 2021. "Tools for measuring the full impacts of agricultural interventions," IFPRI-MCC technical papers 2, International Food Policy Research Institute (IFPRI).
    16. Cristina Bellés-Obrero & María Lombardi, 2022. "Teacher Performance Pay and Student Learning: Evidence from a Nationwide Program in Peru," Economic Development and Cultural Change, University of Chicago Press, vol. 70(4), pages 1631-1669.
    17. Jesus Fernandez-Villaverde, 2020. "Simple Rules for a Complex World with Arti?cial Intelligence," PIER Working Paper Archive 20-010, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania.
    18. Vellore Arthi & James Fenske, 2018. "Polygamy and child mortality: Historical and modern evidence from Nigeria’s Igbo," Review of Economics of the Household, Springer, vol. 16(1), pages 97-141, March.
    19. Irina Gemmo & Pierre-Carl Michaud & Olivia S. Mitchell, 2023. "Selection into Financial Education and Effects on Portfolio Choice," NBER Working Papers 31682, National Bureau of Economic Research, Inc.
    20. J.A. Bikker & J.G.J. Bekooij, 2021. "Market forces in healthcare insurance: The impact of healthcare reform on regulated competition revisited," Working Papers 2104, Utrecht School of Economics.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:245:y:2020:i:c:s0277953619306690. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.