More Knowledge, Better Government? Consequences of Knowledge-Based Decision Making in Swedish Pharmaceutical Benefits

• 成果类型: Article
• 署名作者: Vifell, Asa Casula; Sjogren, Ebba
• 署名单位: Sodertorn University; Stockholm School of Economics
• 刊物名称: GOVERNANCE-AN INTERNATIONAL JOURNAL OF POLICY ADMINISTRATION AND INSTITUTIONS
• ISSN/ISSBN: 0952-1895
• DOI: 10.1111/j.1468-0491.2010.01510.x
• 发表日期: 2011
• 关键词: Public management; ORGANIZATIONS; QUALITY; POWER

摘要

Using an example from the health-care sector, we illustrate consequences of implementing knowledge-based decision making relating to the exercise of political control. The Swedish Pharmaceutical Benefits Board decides the subsidization status of prescription pharmaceuticals. Building on a study of the agency's work, we explore the effects of institutional arrangements stemming from rationalistic demands for knowledgeable and justifiable outcomes related to political structures for control. Knowledge about the medical and economic effects of pharmaceuticals is routinely ambiguous. This makes it necessary to negotiate decision-able knowledge rather than to merely collect it. This touches on matters of broader political consequence, which the formal model for governing the administration does not take into account. This masks decisions as neutral administrative choices. A further conclusion concerns the lack of mechanisms for repoliticizing politically salient issues that have been delegated to administrative bodies.