Deciding subsidy for pharmaceuticals based on ambiguous evidence

Purpose – The purpose of the paper is to inquire into how decisions about public fiscal responsibility for pharmaceutical spending are made and justified when there is a lack of coherent, unambiguous and undisputed evidence about the material characteristics of pharmaceutical use. Design/methodology/approach – This is an exploratory, single‐organisation case study of a Swedish governmental agency tasked with deciding whether prescription pharmaceuticals are included or excluded from the public pharmaceutical benefits scheme. A comparison is made of two intra‐organisational decision‐making processes based on interviews, document studies and participant observations undertaken over a period of two years. Findings – The study shows that providing foundation for making decisions involves attempts to remove ambiguity among multiple knowledge claims about pharmaceuticals' characteristics. Three means of removing ambiguity are outlined. In addition, a fourth means of dealing with ambiguity is identified, when efforts to achieve coherence among multiple sources of knowledge fail. In this case ambiguity about pharmaceuticals' characteristics may be delegated to the individual medical professional to decide about treatment for specific patients. Research limitations/implications – The limited empirical material provides no statistical generalisability of the findings. However, the study has theoretical implications for understanding decision‐making processes in health care institutions. Originality/value – The paper provides a detailed empirical account of a newly created health care assessment organisation similar to those created in other countries to tackle problems of resource allocation.