Skip to main content

Still elegantly muddling through? NICE and uncertainty in decision making about the rationing of expensive medicines in England

Calnan, Michael, Hashem, Ferhana, Brown, Patrick (2017) Still elegantly muddling through? NICE and uncertainty in decision making about the rationing of expensive medicines in England. International Journal of Health Services, 47 (3). pp. 571-594. ISSN 0020-7314. E-ISSN 1541-4469. (doi:10.1177/0020731416689552)

PDF - Author's Accepted Manuscript
Download (470kB) Preview
[img]
Preview
Official URL
http://dx.doi.org/10.1177/0020731416689552

Abstract

This article examines the “technological appraisals” carried out by the National Institute for Health and Care Excellence as it regulates the provision of expensive new drugs within the English National Health Service on cost-effectiveness grounds. Ostensibly this is a highly rational process by which the regulatory mechanisms absorb uncertainty, but in practice, decision making remains highly complex and uncertain. This article draws on ethnographic data—interviews with a range of stakeholders and decision makers (n = 41), observations of public and closed appraisal meetings, and documentary analysis—regarding the decision-making processes involving three pharmaceutical products. The study explores the various ways in which different forms of uncertainty are perceived and tackled within these Single Technology Appraisals. Difficulties of dealing with the various levels of uncertainty were manifest and often rendered straightforward decision making problematic. Uncertainties associated with epistemology, procedures, interpersonal relations, and technicality were particularly evident. The need to exercise discretion within a more formal institutional framework shaped a pragmatic combining of strategies tactics—explicit and informal, collective and individual—to navigate through the layers of complexity and uncertainty in making decisions.

Item Type: Article
DOI/Identification number: 10.1177/0020731416689552
Uncontrolled keywords: rationing, uncertainty, medicines, National Institute for Health and Care Excellence
Subjects: H Social Sciences > H Social Sciences (General)
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Social Policy
Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Lisa Towers
Date Deposited: 01 Feb 2017 10:43 UTC
Last Modified: 23 Jul 2019 07:52 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/60153 (The current URI for this page, for reference purposes)
  • Depositors only (login required):

Downloads

Downloads per month over past year