More Knowledge, Better Government? Consequences of Knowledge‐Based Decision Making in Swedish Pharmaceutical Benefits

Using an example from the health‐care sector, we illustrate consequences of implementing knowledge‐based decision making relating to the exercise of political control. The Swedish Pharmaceutical Benefits Board decides the subsidization status of prescription pharmaceuticals. Building on a study of the agency's work, we explore the effects of institutional arrangements stemming from rationalistic demands for knowledgeable and justifiable outcomes related to political structures for control. Knowledge about the medical and economic effects of pharmaceuticals is routinely ambiguous. This makes it necessary to negotiate “decision‐able” knowledge rather than to merely collect it. This touches on matters of broader political consequence, which the formal model for governing the administration does not take into account. This masks decisions as neutral administrative choices. A further conclusion concerns the lack of mechanisms for repoliticizing politically salient issues that have been delegated to administrative bodies.