Evidence-based policy: rhetoric and reality

Evidence-based policy has been hailed as the current zeitgeist in health care. Its intuitive appeal is clear but its implementation is problematic. This case study demonstrates the practical difficulties of using this approach for purchasing health care. New technologies suffer from limited knowledge about both their long-term benefits and their adverse effects. This undermines attempts to assess effectiveness and efficiency in local populations. Furthermore, the use of evidence should not be assumed to eliminate the need to apply value judgements, which has repercussions for the attainment of equity of access to health care. It is therefore unrealistic to view this approach as a panacea. Rather, evidence-based medicine should contribute to the decision-making process, in conjunction with other considerations such as equity and patient preference.