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

Calnan, Michael .W. and Hashem, Ferhana and Brown, P (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). ISSN 0020-7314. E-ISSN 1541-4469. (doi:https://doi.org/10.1177/0020731416689552) (Full text available)

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

Abstract

This paper examines the ‘technological appraisals’ carried out by NICE (National Institute for Health and Care Excellence) as it regulates the provision of expensive new drugs within the English NHS 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 paper 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 different pharmaceutical products. The study explores the various ways in which different forms of uncertainty are perceived and tackled within these Single Technology Appraisals (STAs). 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 explicit and informal, collective and individual, strategies and tactics to navigate through the layers of complexity and uncertainty in making decisions.

Item Type: Article
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: 18 Aug 2017 09:39 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