Health Services Research Report of a Study (1979) / Chapter Skim
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The Field of Health Services Research
The Field of Health Services Research
Pages 33-44
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From page 33... ...
Health services research employs concepts, theoretical frameworks, data, and methods from the field of medicine and other health professions (nursing, dentistry, pharmacy, etc.) , the social and behavioral sciences, the applied social sciences (social work, business and hospital administration, etc.)
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From page 34... ...
An economist studying the capital expenditures of hospitals to test theories of the behaviors of nonprofit firms, for instance, produces health services research regardless of his intentions and interests. Hence, the analogy with biomedical research and development, which distinguishes between basic and applied research is not entirely applicable to health services.
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From page 35... ...
For instance, among medical sociologists, some are interested in the structure and dynamics of health care organizations and others concentrate primarily on the illness behavior of individuals. Third, groups divide among and within disciplines along particular substantive interests (e.g., mental health services, rehabilitation services)
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From page 36... ...
As these emphases changed and evolved, participation in the field and the varieties of settings in which research is done broadened, and, increasingly, the federal government became its principal source of financial support. The predominant policy issues of various periods in the history of health services in the United States define four general stages of health services research: its origins from 1900 to the 1930s, during which the principal features of the nation's health services industry took shape; the 1930s through the early 1950s, during which voluntary health insurance emerged as the principal mode of financing hospital services; the mid-1950s through the mid-1960s, which witnessed the the extension of federal subsidies for training, hospital construction and planning, and repeated changes in hospital reimbursement by Blue Cross; and from the late 1960s to the present, during which costs, reimbursment, quality of health care, and planning and regulation became ma jar issues .
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From page 37... ...
Among the more than 20 field studies undertaken by the staff or under the C~mmittee's sponsorship were the first major population surveys of use of personal health services, which revealed substantial variations among income groups; projects that laid the groundwork for estimating populations' needs for personal health services; and the pioneering work on the potential benefits of the group practice form of medical care organization. 1930s - 1950 Although the CCMC's recommendations in favor of group practice and the use of ancillary medical personnel, prepayment for personal health services, and community-wide planning for health care did not result in immediate changes in the nation's health services industry, its findings and insights were a major source of information and ideas in the public debate concerning compulsory health insurance that re-emerged during the depressions of the 1930s.
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From page 38... ...
These studies, with the periodic National Health Surveys initiated in 1956 by the Public Health Service, provided systematic descriptive information that revealed continuing differences in volumes of personal health services consumed by the poor and the uninsured as compared to higher income and insured segments of the nation's population. By the early 1960s, research on use of personal health services had become a major area of study for social psychologists and sociologists interested in relationships between social and psychological determinants of utilization and for economists interested in the demand for various types of
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From page 39... ...
When the first explicit appropriations for support of extramural research were made in 1955, the Public Health Service established the Hospital Facilities Study Section, which in 1959 was broadened to become the Health Services Research Study Section. Research on health services during the 1950s produced several landmark studies that incorporated innovative conceptual and methodological approaches.
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From page 40... ...
The traditions of health services research that developed in the 1960s contributed important knowledge and methods that are being employed to infold and assess contemporary health care policy. Rising costs of health care, for instance, have led the federal and state governments to institute several forms of regulatory programs whose effects are being analyzed by health services research.
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From page 41... ...
In such circumstances, the field of health services research is subject to contending forces leading in one direction to research aimed at improving concepts and methods and furthering knowledge about fundamental dynamics within a health services system, and in the other to the application of what is known to the development and assessment of health care policies and programs. These problems of the division of intellectual labor are neither new nor unique to the field of health services research, nor can they be settled by edicts.
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From page 42... ...
Stratton Press, 1973) , 136-149' and David Mechanic, Prospects and Problems in Health Services Research," Milbank Memorial Fund Quarterly/ Health and Society, 56 (Spring, 1978)
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From page 43... ...
Bice, "Certificate-of-Need Legislation and Hospital Costs," in Zubkoff, et" al, Ope cit., pp.
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