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The Convergence of Science and Governance

The Convergence of Science and Governance: Research, Health Policy, and American States

Copyright Date: 2010
Edition: 1
Pages: 184
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  • Book Info
    The Convergence of Science and Governance
    Book Description:

    Daniel M. Fox gives an incisive assessment of the critical collaboration between researchers and public officials that has recently emerged to evaluate the effectiveness and comparative effectiveness of health services. Drawing on research as well as his first-hand experience in policymaking, Fox's broad-ranging analysis describes how politics, public finance and management, and advances in research methods made this convergence of science and governance possible. The book then widens into a sweeping history of central issues in research on health services and health governance during the past century. Returning to the past decade, Fox looks closely at how policy informed by research has been made and implemented in public programs that cover pharmaceutical drugs in most American states. This case study illuminates how politics has informed the questions, methods, and reception of research on health services, and also sheds new light on how research has informed politics and public management. Looking toward the future, Fox describes the promise, as well as the fragility, of the convergence of science and governance, making his book essential reading for those struggling to revise health care in the United States over the next several years.

    eISBN: 978-0-520-94612-5
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface: Converging Stories
    (pp. vii-x)
  4. Acknowledgments
    (pp. xi-xii)
  5. 1. Why Convergence? Why Now?
    (pp. 1-21)

    This book describes and sets in context extraordinary recent events in policymaking for health in American states. Between 2001 and 2008, most states began to make policy as a result of which independent research informs decisions about coverage for pharmaceutical drugs for persons enrolled in Medicaid and the State Children′s Health Insurance Program; and, in a growing number of states, for other health programs.¹ Spending for these programs totals billions of dollars each year. They pay for health care for almost a quarter of Americans.² Medicaid is, moreover, the largest payer for prenatal care, childbirth, and AIDS/HIV.

    These events struck...

  6. 2. Research on Health Services and the Politics of Health
    (pp. 22-50)

    Findings from research on health services have only recently begun routinely to inform aspects of health policy in the United States. But the systematic study of health services has informed and been informed by health politics and policy for a century. This chapter and the next, on state government and health policy, seek to explain why some researchers and some state officials were prepared by the end of the 1990s to do the work that I call convergence.

    Since the early twentieth century, considerable research has examined who, trained and organized how, delivers what health services to whom, at what...

  7. 3. The Competence of States in Health Policy
    (pp. 51-76)

    Policymakers in the executive and legislative branches of state government have become increasingly adept at addressing the complexities of health politics and policy. Their expertise in health affairs prepared them to appreciate and use research evaluating the effectiveness of interventions.

    Federalism is central to the story of the competence of state officials in health policy; but it is not the whole story. Federal funds, regulations and mandates have often been incentives for state officials to become more sophisticated public managers. Other incentives have, however, been independent of the federal government.

    Political scientists and historians often describe three phases of federalism,...

  8. 4. The Drug Effectiveness Review Project
    (pp. 77-103)

    Research on health services and policymaking converged in 2001 when states began to use systematic reviews to inform decisions about covering pharmaceutical drugs for Medicaid programs. Chapter 1 summarized the immediate and underlying causes of this convergence. Chapter 2 described how the politics of the health sector in the United States has influenced the questions and methods of health services research. Chapter 3 explained the growth of states′ responsibilities in health affairs. Chapters 2 and 3 both explained how senior legislators and officials of the executive branch in many states learned how research could inform policy. This chapter describes how...

  9. 5. Can Convergence Be Sustained?
    (pp. 104-130)

    The underlying causes of the convergence of research and health policymaking described earlier in this book remain powerful. Research on the effectiveness and comparative effectiveness of health services is expanding in scope, scale and persuasiveness. Demand is growing—from state and federal policymakers, large corporate purchasers of care, health insurance plans and provider systems—for reliable evidence about effectiveness and quality. Policymakers are intent on containing the growth of spending for health care. The burden of chronic disease increases inexorably.

    Significant potential causes of greater convergence were emerging as this book went into production. The national economic stimulus program (the...

  10. Notes
    (pp. 131-158)
  11. Index
    (pp. 159-168)
  12. Back Matter
    (pp. 169-170)