Reinforcing Science and Policy, With Suggestions for Future Research; Comment on “Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide”

Document Type : Commentary


Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK


Oortwijn et al continue their guide to good practice in the use of deliberative processes in health technology assessment (HTA) based on a survey of international practice. This is useful, and I applaud their care in maintaining objectivity, especially regarding the treatment of moral and politically controversial issues, in reporting how jurisdictions have handled such matters in designing HTA procedures and in their execution. To their suggestions for future research, I add: the historical development of deliberation in healthcare decision-making and in other fields of public choice, with comparisons of methods, successes and failures; development of guidance on the design and use of deliberative processes that enhance decision-making when there is no consensus amongst the decision-makers; ways of identifying and managing context-free and context-sensitive evidence; and a review of high-level capacity building to raise awareness of HTA and the use of knowledge translation and exchange (KTE) and deliberation amongst policy makers, especially in low and middle-income countries.


  1. Oortwijn W, Jansen M, Baltussen R. Evidence-informed deliberative processes for health benefit package design–part II: a practical guide. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.159
  2. Oortwijn W, Jansen M, Baltussen R. Evidence-informed deliberative processes. Step-by-step practical guide for HTA agencies to enhance legitimate decision-making. Nijmegen, the Netherlands. Published 2019.
  3. Oortwijn W, Jansen M, Baltussen R. Evidence-Informed Deliberative Process: A Practical Guide for HTA Bodies for Legitimate Benefit Package Design. Nijmegen: Radboud University Medical Center; 2021.
  4. Culyer AJ. Perspective and desire in comparative effectiveness research: the relative unimportance of mere preferences, the central importance of context. Pharmacoeconomics. 2010;28(10):889-897. doi:2165/11535270-000000000-00000
  5. Culyer AJ. Cost, context, and decisions in health economics and health technology assessment. Int J Technol Assess Health Care. 2018;34(5):434-441. doi:1017/s0266462318000612
  6. Česnulaitytė I. Models of representative deliberative processes. In: Peña-López I, ed. Innovative Citizen Participation and New Democratic Institutions: Catching the Deliberative Wave. Paris: OECD Publishing; 2020. doi:1787/36f3f279-en
  7. Smith G, Wales C. Citizens' juries and deliberative democracy. Polit Stud (Oxf). 2000;48(1):51-65. doi:1111/1467-9248.00250
  8. Watt AM, Hiller JE, Braunack-Mayer AJ, et al. The ASTUTE Health study protocol: deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment. Implement Sci. 2012;7:101. doi:1186/1748-5908-7-101
  9. Habermas J. Strukturwandel der Öffentlichkeit. Suhrkamp Verlag: Frankfurt. 1962. Trans Thomas Burger and Frederick Lawrence as The Structural Transformation of the Public Sphere. Cambridge, Massachusetts: The MIT Press; 1989.
  10. Mendelberg T. The deliberative citizen: theory and evidence. In: Carpini MD, Huddy L, Shapiro RY, eds. Political Decision Making, Deliberation and Participation: Research in Micropolitics. Amsterdam: Elsevier; 2002. p. 151-193.
  11. Lindblom CE. The science of "muddling through.” Public Adm Rev. 1959;19(2):79-88. doi:2307/973677
  12. Petts J. Barriers to participation and deliberation in risk decisions: evidence from waste management. J Risk Res. 2004;7(2):115-133. doi:1080/1366987042000158695
  13. Lomas J, Culyer T, McCutcheon C, McAuley L, Law S. Conceptualizing and Combining Evidence for Health System Guidance. Ottawa: Canadian Health Services Research Foundation; 2005.
  14. Rosen R. Applying research to health care policy and practice: medical and managerial views on effectiveness and the role of research. J Health Serv Res Policy. 2000;5(2):103-108. doi:1177/135581960000500208
  15. Mitton C, Patten S. Evidence-based priority-setting: what do the decision-makers think? J Health Serv Res Policy. 2004;9(3):146-152. doi:1258/1355819041403240
  16. Dobrow MJ, Goel V, Upshur RE. Evidence-based health policy: context and utilisation. Soc Sci Med. 2004;58(1):207-217. doi:1016/s0277-9536(03)00166-7
  17. Greenhalgh T, Worrall JG. From EBM to CSM: the evolution of context-sensitive medicine. J Eval Clin Pract. 1997;3(2):105-108. doi:1046/j.1365-2753.1997.00096.x
  18. O'Brien N, Li R, Isaranuwatchai W, et al. How can we make better health decisions a Best Buy for all?: Commentary based on discussions at iDSI roundtable on 2nd May 2019 London, UK. Gates Open Res. 2019;3:1543. doi:12688/gatesopenres.13063.2