Health Policy and the Politics of Evidence

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence‐based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre‐eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision‐making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision‐making.     

开放型商业模式NICE属性与价值创造关系的实证研究

企业竞争优势或价值创造的源泉在哪里,或者企业绩效异质性的成因是什么?这一问题一直是战略管理领域的研究焦点。移动互联网时代,企业纷纷通过重塑商业模式来实现转型升级或跨界发展,并将其作为价值创造和竞争优势的一种重要来源。因此,本文旨在以开放型商业模式为研究对象,探讨其内在属性与价值创造之间的关系。首先,本文阐述开放型商业模式的内涵及构成;接着,识别出其内在属性特征,即新颖性(N)、锁定性(I)、互补性(C)、效率性(E);同时,重点借助战略网络理论、新木桶理论、平台经济学等理论基础论证NICE与价值创造间的关系及背后的作用机理,提出理论假设;最后,运用调查问卷和结构方程模型的方法实证检验,且演绎结论的管理含义。本文所使用的数据来源于中国最大的服务交易平台:猪八戒网和EMBA、MBA、EDP等项目课堂。研究表明,开放型商业模式新颖性与企业价值正相关、互补性与顾客价值正相关、效率性与企业价值和伙伴价值均呈正相关关系;而新颖性与顾客价值及伙伴价值正相关;互补性与企业价值及伙伴价值呈正相关关系等结论未得到印证。本文的研究回答了"企业竞争优势或价值创造源泉在哪里?"这一问题,并且本文的理论机理分析和实证结论有利于指导企业创新商业模式并获取竞争优势的战略决策。