214 Chapter 7 Co-creating with policymakers The research papers portrayed in this thesis were mainly developed through collaboration with other academics, using our best understanding of what evidence is relevant to policymaking. There is, arguably, a best way to identify and study policy-relevant questions: by engaging with policymakers, learning what evidence they need and eventually cocreating the research project. During this PhD trajectory, a considerable amount of time was invested in setting up a project in collaboration with the municipality of Rotterdam and the health insurer VGZ. This collaboration was anchored in the academic workplace CEPHIR, a structure developed to bring together researchers from the Department of Public Health of EramusMC and policymakers and practitioners of Rotterdam-Rijnmond, Zeeland and Zuid-Holland Zuid. The research idea aimed at evaluating the municipal health insurance policy (Gemeentepolis) for low SES individuals. Under the name of Rotterdampakket, this policy was mainly composed of discounts, subsidies and other support for insurance-related costs, including the deductible. It had been available for several years, during which it aimed to prevent care avoidance due to financial barriers and protect against debts resulting from service use. At the time of the collaboration, changes were planned to the policy due to modifications required in discounting health insurance premiums. Hence, there was a solid reason to evaluate the effectiveness of its several components, inform the redesign of this protection mechanism. To do this, the research team suggested a regression-discontinuity design. Unfortunately, the collaboration did not move past the initial phase, despite many hours of work for almost three years and funding secured through the municipality of Rotterdam. Interestingly, the main barriers were placed by the need to bring several data sources together, a threat to conducting quasi-experiments discussed in Chapter 6. The failure of co-creation between academic and non-academic stakeholders is part of the challenge to develop them. However, as Academia moves more and more towards this approach, learning from these failures should increase the efficiency of failures to come. Some of the relevant lessons are described next. The critical challenge to this project was the lack of municipality data to identify program users, which was only possible through health insurer records. The inexistence of these data in the Municipality was unexpected given their role in the program; it should have been identified earlier. The only option was, therefore, to bring health insurer data into CBS data infrastructure. Unfortunately, this was assessed by one CBS legal advisor as inappropriate due to concerns with the commercial interest of insurers. Throughout the several discussions around the legal and practical ways to link the data, the researchers lacked privacy and data governance expertise and support. Despite the right resources being activated within EramusMC, there was limited commitment to moving the project forward. Support was, on the other hand, provided by senior Academics when needed. This was particularly important because the collaboration was led only by junior researchers, who often needed someone else to “unblock” the road. Last, the most positive aspect of this experience was the effort made by Rotterdam municipality stakeholders to make the project happen. Their commitment
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