Health Services Research Report of a Study (1979) / Chapter Skim
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Health Services Research in the Federal Government
Health Services Research in the Federal Government
Pages 45-74
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From page 45... ...
Federal Involvement in Health Services Research To identify the agencies that might be engaged in health services research, the committee reviewed several published analyses of federal spending for health-related research and development and statistical activities. These reviews revealed that existing reports do not consistently and reliably record health services research as defined in Chapter 2.
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From page 46... ...
The Department of Labor's concerns with labor force participation, collective bargaining, and wage rates encompass workers the health services industry. In the Congress, the General Accounting Office assesses federally funded health programs, and the Congressional Office studies the potential costs of proposed health legislation.
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From page 47... ...
The Health Care Financing Administration and all six agencies of the Public Health Service conduct health services research; each of the offices of planning and evaluation sponsor additional research to inform their policy decisions. (Their organization interrelationships are displayed in Figure 4.)
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From page 49... ...
The mandate of HCFA's Office of Policy Planning and Research is broadly interpreted, and most types of health services research could fall within its purview. Federal Expenditures for Health Services Research Health services research has several different methods of support by the federal government, including intramural activities of federal employees and extramural studies performed by nonfederal persons.
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From page 50... ...
Records maintained by federal agencies do not reliably and consistently distinguish funds invested in health services research frog those devoted to other types of research or to routine data collection and reporting for program management. Enumerating funds for health services research was especially difficult in agencies that supported large-scale demonstration and education projects in which most funds were devoted to service activities.
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From page 51... ...
(98.9) Health, Education, and Welfare 121,837.7 85.5 State 10,029.0 7.0 Defense 4,981.0 3.5 Veterans Administration 4,100.0 2.9 National Aeronautics and 100.0 0.1 Space Administration Labor 71.0 0.1 Congressional Agencies (total)
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From page 52... ...
By hi Ad lo; By H EN U)
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From page 53... ...
National Center for Health Services Research National Center for Health Statistics National Institutes of Health* Alcohol, Drug Abuse, and Mental Health Administration Health Care Financing Administration Together, these agencies accounted for about 80 percent off all 1977 DREW expenditures for health services research and about 70 percent of all federal expenditures in this area.
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From page 54... ...
Office of Health Policy, Research, and Statistics 389.9 National Center for Health Services Research National Center for Health Statistics Health Resources Administration (total) Bureau of Health Manpower Bureau of Health Planning and Resources Development Health Services Administration (total)
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From page 55... ...
The study covered all agencies of the Public Health Service (except the National Center for Health Statistics, the Center for Disease Control, the Food and Drug Administration, and the National Institutes of Health) and the Health Care Financing Administration.
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From page 56... ...
56 FIGURE 5 AGENCY MISSIONS AND RESEARCH INTERESTS American ,,' Indians Q o A O Medicare <' Beneficiaries o Veterans Mental Dental Diabetes HEALTH PROBLEMS 1/'~7~ it 1 ~— -- .
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From page 57... ...
Includes extramural projects of the Office of Health Policy, Research, and Statistics, National Center for Health Services Research, Bureau of Health Manpower, Bureau of Health Planning and Resources Development, Bureau of Community Health Services, Bureau of Medical Services, Indian Health Services, Alcohol, Drug Abuse, and Mental Health Administration, and Health Care Financing Administration; and intramural activities of the National Center for Health Services Research. Excludes Divisions of Dentistry and Nursing.
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From page 58... ...
A, At lo; E" H HI up By lo} Up V]
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From page 59... ...
Table 6 shows, for instance, that HCFA accounted for nearly half of the monies invested in research on health insurance, planning, and regulation, for nearly two-thirds of the funds devoted to research on health care expenditures, and for about onefifth of the funds for studies of the disadvantaged. NCHSR was also a major source of support for research on health care planning and regulation (40 percent)
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From page 61... ...
A major problem in their view is the lack of clear and accurate information about the research priorities of the various agencies that support extramural research. Others take the position that the ad hoc and sporadic research interests of agencies militate against the continuity and stability required to address fundamental and long term questions.
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From page 62... ...
Research in this area sponsored by the Alcoholism, Drug Abuse, and Mental Health Administration focuses on influences of behavioral disorders and "life crises" on the use of services. Studies conducted by the Health Care Financing Administration concentrate on the use of services by Medicare and Medicaid beneficiaries.
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From page 63... ...
Fragmentation and Gaps The committee found that fragmentation and gaps in the organization of responsibilities for health services research are endemic in the federal government. The close identification of research programs with agencies' missions produces a great variety of studies and analyses, each dealing with limited aspects of larger issues and leaving relatively unattended issues that are not the principal concerns of operating agencies.
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From page 64... ...
Superordinate layers of departments, therefore, have limited control over the program and daily activities of their constituent agencies and no authority over agencies in other divisions and departments of the government. DREW, for instance, has no official involvement in the health services research programs of the Department of Defense or the Veterans Administration; within DREW, the Public Health Service housing NCHSR and NCHS is statutorily and administratively separate from the Health Care Financing Administration which has substantial programs in health services research.
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From page 65... ...
that * The Health Care Financing Administration, The National Center for Health Services Research, and the National Center for Health Statistics.
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From page 66... ...
In view of its findings of important matters missing from the research priorities of individual agencies within the Department of Health, Education, and Welfare, created by the close identification of agencies' health services research priorities with their program missions, the committee recommends that agencies be identified to assume responsibilities for implementing studies to bridge the gaps in knowledge. These agencies should periodically review their own research agendas and those of other agencies with common or logically related interests, identify research needs that are not being met, and propose projects that would meet these needs.
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From page 67... ...
In consequence, the worthiness of research proposals has been judged in terms of the likelihood that they will provide the information needed by the sponsoring agency, as well as on grounds of scientific merit. As programmatic needs for particular types of information have increased throughout the government, use of the contract mechanism to support extramural research has grown, and intramural activities have enlarged.
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From page 68... ...
Having found that substantial portions of federal spending for health services research are disbursed for extramural studies, the majority through contracts, and that most of these disbursements are made without the benefit of systematic and open peer review, the committee recommends that all Executive departments and agencies sponsoring extramural studies in health services research establish peer review by nongovernment personnel of all projects involving appreciable expenditures. These procedures should (1)
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From page 69... ...
In other cases, government agencies produce information for general dissemination, such as the statistical series on federal expenditures for health services for Medicare beneficiaries published by the Health Care Financing Administration and the various series published by the National Center for Health Statistics. Nearly 30 percent~of all federal expenditures for health services research are for intramural activities.
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From page 70... ...
Intramural research is best suited to deal with the problems for which standard solutions exist and for which there are high specific or routine needs for information. Most studies performed by the National Center for Health Statistics are in this category.
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From page 71... ...
71 FIGURE 6 RESEARCH FUNDING STRATEGY Needs for Information Targeted or Routine Wellestablished State-ofthe-art Not wellestablished Not Targeted or Routine A B Intramural Contract or I Intramural ... C D Contract Grant .
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From page 72... ...
72 research that will be done and for the quality of health services research, the committee recommends that the federal government adopt a policy regarding health services research to assure that a signifi cant portion of all monies invested in this area go to support investigator-initiated extramural research. Intramural research should not be viewed as a substitute for extramural research, nor contracted research as a substitute for grant-supported investigator-initiated research.
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From page 73... ...
77-1185 (June 1977) : John Craig, Mega McDonald, and Betty Dooley, "Private Foundations' Health Expenditures: A Survey Analysis," Health Policy Research Group, Georgetown School of Medicine, May, 1978.
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