Health Services Research

The study of health care delivery systems uses social science and economic analysis to span the gulf between research, practice, and policy. Health services research can be characterized in four general categories of investigations:

    1.  

    clinical (studies of providers and patients and their influences on the process and outcome of care),

    2.  

    institutional (studies that emphasize organizational and administrative aspects of service delivery),

    3.  

    systemic (analyses of the interrelation among providers, institutions, and demands for care, including the financing and regulation of service), and

    4.  

    environmental (assessments of the influence of social, political, and economic forces on the delivery and effects of health care).

    Services research often contributes to the development and implementation of health care policies through (a) documentation (health care indicators and markers specify and describe problems), (b) causal and correlational analyses (relationships are identified and policy influences are assessed often using demonstration programs), and (c) prescriptions (strategic models outline implementation requirements and provide guidelines for policy development) (Brown, 1991).

    Although the formal link between services research and policy formation can be traced most directly to the development, implementation, and analysis of Medicaid and Medicare during the 1960s, health services research evolved from descriptive and analytic investigations beginning in the first decade of the twentieth century (Ginzberg, 1991). The complexity of contemporary medical markets increases the importance of health services research and the dependence of policymakers on the data and results from these investigations. This complexity and need for data is strongly felt by community-based drug treatment organizations (CBOs) in their current environment.

    Only recently has services research been applied to the study of treatment services for alcohol and drug dependence. The ADAMHA Reorganization Act of 1992 (P.L. 101-321) separated the funding of research and practice in this field. The Act placed the research institutes (National Institute of Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and National Institute of Mental Health) under the auspices of the National Institutes of Health. At the same time, the service-focused agencies (Office for Treatment Improvement and the Office of Substance Abuse Prevention) were renamed the Center for Substance Abuse Treatment and the Center



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