Collective constructions of 'waste': epistemic practices for disinvestment in the context of Dutch social health insurance.
Floortje B MoesEddy HouwaartDiana DelnoijKlasien HorstmanPublished in: BMC health services research (2019)
This case shows that - apart from the right data and adequate expertise - disinvestment requires clinical leadership and political will on the part of stakeholders. Our analysis of the Institute's Appropriate Care program shows how the epistemic effort to identify low-value care became a co-construction between policymakers, care providers, patients and insurers of problems of 'waste' in Dutch social health insurance. This collective epistemic work gave cognitive, moral and political standing to the idea of 'waste' in public health expenditure.
Keyphrases
- health insurance
- affordable care act
- healthcare
- quality improvement
- public health
- mental health
- palliative care
- heavy metals
- end stage renal disease
- newly diagnosed
- primary care
- chronic kidney disease
- ejection fraction
- municipal solid waste
- sewage sludge
- pain management
- peritoneal dialysis
- prognostic factors
- life cycle
- machine learning
- risk assessment
- electronic health record
- anaerobic digestion