Science and Policy in Interaction: On practices of science policy interactions for policy-making in health care

In times of crisis, such as in the case of the volcanic ash cloud, the role of science in policy-making processes becomes more apparent than in ‘normal’, less controversial times. There is, however, hardly a policy area imaginable where science is not involved – even though that role, in general, stays hidden from the public at large. In the Netherlands, policy programmes such as the financial reform in the health care sector or those that support health promotion rely upon scientific knowledge. In less controversial times as well, on the smaller scale of policy programmes and single policy measures, policy makers do not act without the involvement of scientists. Scientific input is needed to answer policy questions such as: How can we keep citizens healthy and safe, how can we safeguard affordable health care among ageing Dutch citizens, and how can we maintain good quality of health care while increasing the efficiency of health care practices? The growing need for scientific knowledge brings along tension between the need for more evidence-based policy, and the fear of a technocratic and uncritical or uncontrollable role of science in policy-making. This paradox of scientific authority, as Bijker, Bal and Hendriks (2009) put it beautifully – needing knowledge for policy-making processes versus a critical attitude towards using science in policy-making – emphasises the importance of questioning the role of science in policy-making: How can we understand this role? What are the consequences of close interaction between science and policy? And, if we want to improve the effectiveness of scientific evidence in policy, how can we achieve this? This thesis addresses these questions, taking health care and economic thinking on health care as its focus of investigation.