Informing Judgment: Case Studies of Health Policy and Research in Six Countries


The authors of the case studies in this report describe and assess collaborative efforts using evidence from research to guide policymaking for health care. Each case study is itself collaborative. Researchers and public-sector policymakers are co-authors of three cases (Australia, British Columbia, Norway); executives of pharmaceutical firms joined in writing two cases (South Africa, United Kingdom); one case is the work of a policymaker and researchers at a large nonprofit health care organization in the United States (Kaiser Permanente); and in one instance public officials helped to prepare the case but declined co-authorship (South Africa).

At an editorial meeting in October 2000 the authors agreed on one overriding generalization about collaboration to use research in policymaking: The proper purpose of collaboration between researchers and policymakers is to use evidence from research to inform judgments for which policymakers are accountable. The Introduction describes the implications of this generalization for researchers and policymakers, implications that are practical and often painful. For example, setbacks in implementing policies described in the case studies have occurred in four of the six countries since the authors met.

Andrew D. Oxman, then Chair of the Cochrane Collaboration Steering Group, and Daniel M. Fox, President of the Milbank Memorial Fund, organized the project that led to this report. The Cochrane Collaboration is a nonprofit international organization, founded in 1993, that aims to help people make well-informed decisions about health care by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of health care interventions. The Milbank Memorial Fund is an endowed foundation, founded in 1905, that works with decision makers and researchers on significant issues in health policy. The Fund participated in some of the activities that led to the creation of the Cochrane Collaboration and has helped to bring systematic reviews to the attention of the people responsible for health care policy, particularly in the United States.

We thank Andy Oxman and the authors for persisting in this project despite the distraction of their other obligations. We also thank two staff members of the Fund who have considerable experience in research and policymaking for reviewing the next-to-final drafts of the Introduction and the cases: Paul Cleary, Editorial Director and Professor of Health Care Policy at Harvard Medical School; and John Colmers, Program Officer and former Executive Director of the Maryland Health Care Commission.

Mike Clarke
Deputy Chair
Cochrane Collaboration Steering Group

Daniel M. Fox
Milbank Memorial Fund

Peter Langhorne
Cochrane Collaboration Steering Group