The Politics of Evidence Use in Health Policy Making in Germany: The Case of Regulating Hospital Minimum Volumes

This chapter examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Federal Joint Committee (GBA) as the regulator. Minimum volume regulation was inspired by evidence suggesting a positive relationship between service volume and patient outcomes for complex surgical interventions. Federal legislation was introduced in 2002, delegating the selection of services and the setting of volumes to corporatist decision-makers. Evidence has been key to support, and challenge, decisions about minimum volumes, both in the GBA and in court. The analysis highlights the dynamic relationship between evidence use and the political and institutional context of health policy making, characterised by the legislative nature of policy-making, corporatism, and the role of the judiciary in reviewing policy decisions.