A collaboratively-derived science-policy research agenda

The need for policy makers to understand science and for scientists to understand policy processes is widely recognised. However, the science-policy relationship is sometimes difficult and occasionally dysfunctional; it is also increasingly visible, because it must deal with contentious issues, or itself becomes a matter of public controversy, or both. We suggest that identifying key unanswered questions on the relationship between science and policy will catalyse and focus research in this field. To identify these questions, a collaborative procedure was employed with 52 participants selected to cover a wide range of experience in both science and policy, including people from government, non-governmental organisations, academia and industry. These participants consulted with colleagues and submitted 239 questions. An initial round of voting was followed by a workshop in which 40 of the most important questions were identified by further discussion and voting. The resulting list includes questions about the effectiveness of science-based decision-making structures; the nature and legitimacy of expertise; the consequences of changes such as increasing transparency; choices among different sources of evidence; the implications of new means of characterising and representing uncertainties; and ways in which policy and political processes affect what counts as authoritative evidence. We expect this exercise to identify important theoretical questions and to help improve the mutual understanding and effectiveness of those working at the interface of science and policy

Governing drug reimbursement policy in Poland: The role of the state, civil society, and the private sector

This article investigates the distribution of power in Poland’s drug reimbursement policy in the early 2000s. We examine competing theoretical expectations suggested by neopluralism, historical institutionalism, corporate domination, and clique theory of the post-communist state, using data from a purposive sample of 109 semi-structured interviews and documentary sources. We have four concrete findings. First, we uncovered rapid growth in budgetary spending on expensive drugs for narrow groups of patients. Second, to achieve these favorable policy outcomes drug companies employed two prevalent methods of lobbying: informal persuasion of key members of local cliques and endorsements expressed by patient organizations acting as seemingly independent “third parties.” Third, medical experts were co-opted by multinational drug companies because they relied on these firms for scientific and financial resources that were crucial for their professional success. Finally, there was one-way social mobility from the state to the pharmaceutical sector, not the “revolving door” pattern familiar from advanced capitalist countries, with deleterious consequences for state capacity. Overall, the data best supported a combination of corporate domination and clique theory: drug reimbursement in Poland was dominated by Western multinationals in collaboration with domestically based cliques.Piotr Ozieranski is indebted to the Department of Sociology, University of Cambridge and St Edmund’s College for research grants

Kingstar Winning: From Electronic Medical Records to Integrated Healthcare in China

Kingstar Winning’s president, Zhou Wei, sought to position his company for faster growth in anticipation of a market shakeup among providers of electronic medical records (EMRs) and e-health solutions to hospitals in China. The options he was considering included expanding the company’s domestic project base, a domestic merger or acquisition, and international growth, possibly through a joint venture project with Huawei. The case describes the history and growth of Winning, contextualizes the transition from paper to electronic medical records underway in China, analyzes Winning’s approach to EMR development through “software as a service” and a “flexible R&D mode,” and evaluates specific projects at two hospitals in the Shanghai region. Financial data is provided for the company, along with market projections and additional information on the use of EMRs

Healthcare in China: Institutional Trajectories and Future Opportunities

China’s healthcare system was undergoing significant growth in the early 2010s, evidenced by expanded government-backed insurance and experiments with private clinics, hospitals, and insurance. Reforms under discussion would further restructure relations among insurers, hospitals, physicians, and patients. Policy changes also were likely to change competitive dynamics in major healthcare industries, and especially for pharmaceutical, biotechnology, and medical device and diagnostics companies. This case summarizes the institutional history of China’s healthcare system and identifies dilemmas for reform, especially in the insurance system and payment structures for hospitals and physicians. A final section analyzes opportunities for healthcare innovation and systems integration in China. The case is designed to help students learn about the Chinese healthcare system overall as well as strategic choices faced by insurance firms, hospitals, and pharmaceutical and medical device companies. It also can be used to analyze moral hazards, opportunity costs, and systems integration in healthcare more generally