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Commentary: understanding the underlying politics of health care policy decision making.

Article Excerpt
The work by Marsha Gold on identifying the pathways that influence policy makers' use of health services research is a very important report for this field (Gold 2009). Using an in-depth analysis of the social science literature in this area, as well as sage insights from her own experience as an interlocutor between researchers and policy makers, Gold's article develops a framework for improving the presentation of research findings to policy makers. This will undoubtedly be useful for many researchers.

The pathways in Gold's article are premised on the fact that health care policy maker decisions are influenced by "underlying politics." We suggest that it is also important to understand these underlying politics. For individual research results to have a more significant impact on policy decisions, they must reflect a deeper understanding of the context in which these decisions are made. Researchers must identify specific topics for study that have policy leverage and present them in a manner that corresponds to the way that policy makers think about these issues. We want to emphasize that understanding the politics of health policy is not an invitation to alter research results so that they align with political interests, but rather an opportunity to better match unbiased, scientific research to policy makers' priorities in order to help ensure that health services research findings are more relevant and meaningful to the decision making audience.

We believe that to do this requires researchers to understand more broadly the history and politics of health care issues and how these factors, on one hand, narrow the usefulness of particular research results and, on the other hand, make certain research results critically important to a policy debate. In order to provide researchers with this understanding, the field of health services research will have to make a greater commitment to the study of the politics of health care policy decision making itself.

What is too often missing from the field of health services research--and thus from the tool kit of individual researchers--is an awareness of how explicitly political factors such as partisanship, voters' views, the beliefs of key interest groups, the nature of media coverage, and the jurisdictional responsibilities of Congressional committees shape the receptivity to or lack of interest in particular research results.

Surprising as it may seem, we also lack independent knowledge of the factors influencing policy positions of health care-specific professional groups and institutions, such as those serving physicians, nurses, hospitals, and medical scientists. Health services research results may get less attention from these professional groups...

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