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PREFACE This is a good report. It may seem odd for the chairman of the committee that submitted the report to open with that statement, but feel justified in doing so, because I was an interested amateur. I suppose that is one reason why I was chosen as chairman. I did not know enough about the subject to be biased, and as a former medical school dean I had had some experience in chairing meetings attended by people with divergent views. The committee heard testimony from a variety of individuals repre- senting both public and private agencies, and the staff explored the extent of the health services research enterprise among the various federal agencies. In reviewing the evidence generated by these activi- ties the committee became aware of two underlying and recurring themes. The first was a sense of disappointment in the usefulness to policymakers of the product of health services research, and the second was confusion about what constituted the field. Disappointment leads to criticism and much of the criticism was directed at the National Center for Health Services Research. Why, for example, could not the Center provide quick and easy answers to questions about health manpower or cost containment that would be immediately applicable to federal policy? This in turn led to questions of organization. Should the Center be expanded to control all research in the field, or should it be eliminated, or simply reorganized again? Should control of health services research be centra- lized or decentralized, should more be done intramurally or more extra- murally, and, by the way, do we all agree on what should be labeled health service research? The report deals with these complex issues and in my view makes some sensible comments and recommendations, which include: Health services research has suffered because of unrealistic expectations of what it could provide in the way of easy answers for policymakers in the health field. There are no quick fixes for problems of health manpower and distribution or cost containment. This does not mean that health services research is unimportant. On the contrary, it means that it is enormously important to know much more than we do about the complex variety of factors affecting our health care system if we are to make sensible policy decisions. ix
