Health Services Research Report of a Study (1979) / Chapter Skim
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The National Center for Health Services Research
The National Center for Health Services Research
Pages 75-102
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From page 75... ...
Some hold that there is no need for a general-purpose health services research agency, arguing that its functions could be absorbed by other federal agencies. Others, taking the view that a strong and highly visible general-purpose research agency is essential, favor broadening NCHSR's functions and strengthening its position in the federal government.
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From page 76... ...
Programs such as those for community action, demonstration cities, and neighborhood and migrant health vastly increased requirements for intragovernmental coordination and information for their management. The needs became more acute in the mid-1960s, when the federal government enacted Medicare and Medicaid, and expanded community health planning under the Regional Medical Programs and Comprehensive Health Planning efforts.
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From page 77... ...
Scattered responsibilities for categorical federal health care delivery programs, combined with rising health care costs, led to recommendations for a federal agency to coordinate the government's research efforts and to discover ways of improving the performance of the nation's health care industry. In his 1967 Health and Education Message to the Congress, President Johnson ordered the creation of such an agency in the Department of Health, Education, and Welfare.
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From page 78... ...
These goals were reflected in NCHSR&D's statement of program concerns submitted to the Congress in 1969.~7] The Center was to: -- be a resource to the federal government by assembling and disseminating information about health services and health services research from the United States and abroad, and · assisting other federal agencies to plan, establish priorities, and cooperate in joint endeavors; support through its extramural grants program study of the organization and financing of health care, use of personnel and resources, and other fundamental problems in the health care industry; -- develop operational definitions and knowledge about preconditions for the establishment and maintenance of effective and efficient health services; -- encourage demonstration and testing of innovative approaches to health services delivery and management by
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From page 79... ...
NCHSR&D's program in health manpower financed the training of former medical corpsmen and other ancillary personnel; its efforts to improve the quality of health services led to the Experimental Medical Care Review Organizations; several projects were initiated to facilitate the collection and use of health services information by state and local planning agencies; and its Experimental Health Services Delivery Systems program was aimed at developing and testing new forms of local and state organizations to consolidate the planning and management of community-wide health services delivery systems. Fran 1970 to 1973, these and other developmental efforts accounted for nearly half of the monies disbursed by NCHSR&D for new activities.
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From page 80... ...
Experts from outside the federal government were appointed to study section panels to review the scientific and technical merits of * Initially, these included the Indian Health Service, Federal Health Programs Service, Community Health Service, National Institute of Mental Health, National Communicable Disease Center, Health Facilities Planning and Construction Service, Regional Medical Program Service, National Center for Health Statistics, and NCHSR&D.
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From page 81... ...
* was placed in the Health Resources Administration, along with the National Center for Health Statistics, the newly created Bureau of Health Planning and Resources Development (BHPRD)
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From page 82... ...
The great majority of funds employed to finance the Experimental Health Services Delivery System, the Federal-State-Local Data Systems and other largescale projects were devoted to developmental activities and relatively * These budget figures refer to funds available for support of research and training programs and do not include costs of administering the agency.
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From page 83... ...
* Includes special appropriation of $1.5 million for research on emergency medical services.
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From page 84... ...
program dealt with prototypes of the Professional Standards Review Organizations created by 1972 amendments to the Social Security Act; its Experimental Health Services Delivery Systems (EHDS) projects, which attempted to test the feasibility of local management of health care programs by community organizations, was terminated with the enactment of the National Health Planning and Resources Development Act of 1974.
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From page 85... ...
After a series of meetings involving persons from government, the health care industry, and the health services research community,[9] the Center has identified nine priority areas for research and demonstration.tl0~: · Quality of care Productivity and cost of inflation · Health care and the disadvantaged · Health manpower Health insurance · Planning and regulation
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From page 86... ...
93-353 to disseminate information about health services, the Center co-sponsors regional 'dissemination workshops" at which local officials and health professionals participate with selected researchers to discuss what is known from health services research about national and local health care issues. Finally, the Center supports eight centers for health services research located in universities and health care institutions.
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From page 87... ...
Specifically, what ought to be its principal objectives, and where within the federal structure should the agency be located? Coordination of a General-Purpose Research Agency The problems that led to the creation of the National Center for Health Services Research endure, including needs for: research on fundamental problems in organization, financing, planning, and regulation of health services; evaluations of health care programs; validating and synthesizing knowledge from health services research and related fields of inquiry; coordinating and assisting activities of federal agencies involved in health services research; · developing the nation's capacity to conduct research, demonstrations, and evaluations that will improve understanding and inform decisions; · supporting programs for training in health services research to assure an adequate supply of appropriately trained investigators.
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From page 88... ...
The Bureau of Health Planning and Resources Development, for instance, shares the Center's interests in health care planning and regulation; the National Center for Health Statistics, its concern with gathering and analyzing health care utilization and expenditure information; the Bureau of Health Manpower, its focus on the development and use of new personnel; and the service delivery programs of the Health Services Administrations its interests in effects of organizational innovations on the management of health care institutions and on improving access to care. In sum, some observers believe that the National Center lacks a substantive focus of its own.
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From page 89... ...
Studies supported by the National Center usually are less program~atically oriented and are more likely than projects funded by operating agencies to deal with pervasive conceptual and methodological problems and fundamental substantive issues. The National Center views the development of innovative research methods to be applied in health services research as one of its principal missions.
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From page 90... ...
Several agencies deal with problems that, while important, do not receive the continuous and heightened attention of high-level policy makers. When such matters as emergency medical services, pharmaceutical practices, and dental care are eclipsed by major issues pertaining to the costs and quality of health care, tying research to the programs that deal with less visible problems tends to assure its neglect.
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From page 91... ...
93-353 that 25 percent of the Center's budget support intramural research and the mandating of health services research centers, in effect, shifted funds from monies available for competitive grant and contract awards to nondiscretionary, fixed obligations. These decisions must be regarded as preferences of the Congress for particular means of conducting and supporting health services research rather than as an expression of its lack of confidence in health services research or in the National Center.
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From page 92... ...
to sponsor health services research and research in related disciplines through a program of extramural, investigator-initiated grants and contracts; to conduct intramural research; to sponsor through a program of extramural grants and contracts training in health services research and related disciplines; to monitor the development of knowledge relevant to health services research, and disseminate this knowledge; to assist other federal agencies in developing health services research priorities and programs and in designing and executing evaluations of federal programs; and
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From page 93... ...
Therefore, the Center's purview must not be limited to particular types of questions. Indeed, the Center should be encouraged to pursue research on issues that are related to the principal focuses of operating agencies and should be accorded the opportunity to be designated as the lead agency in coordinating and developing important areas of health services research that are not tied directly to other agencies' missions.
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From page 94... ...
Specifically, the committee recommends that the NCHSR be permitted to re-institute its _ support of health services research training, based on a careful review of the most appropriate mix of disciplines and levels of training deserving of support. Centers Program On advice frog the Health Services Research Study Section, a program to support health services research and development center grants was launched in early 1968 by the then Division of Medical Care Administration and subsequently expanded by the newly created National Center for Health Services Research and Development.
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From page 95... ...
While a portion of these funds may be used to design projects and to support small-scale, exploratory and feasibility studies, their principal purposes are to provide at least partial salaries for a full time director and associated staff and to cover administrative costs. With this relatively meager support, the centers are expected to engage in several activities, including research, technical assistance to local health care institutions and agencies, and providing opportunities for training.
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From page 96... ...
Intramural Research The committee recognizes that the National Center for Health Services Research requires a strong intramural research effort to attract and keep qualified researchers. Such persons are needed to assist other federal agencies in their health services research activities; to develop NCHSR priorities; to monitor health services research studies and literature; to identify, summarize, and critique methods and findings; and to conduct studies that are best done within the government.
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From page 97... ...
The effects of a budgetary minimum for intramural research are further compounded by reducing the resources that would otherwise be available for investigator-initiated extramural research. In 1978, the intramural reserve was nearly three times the monies available to support new extramural research.
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From page 98... ...
Con: 1. Unable to influence directly the health services research activities of the Health Care Financing Administration and other non-PHS agencies.
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From page 99... ...
Located above all DHEW programs, including HCFA; better able to coordinate research priorities and integrate and synthesize research findings.
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From page 100... ...
After considering the issue of the location of the National Center, the committee concluded that there are no compelling grounds for recommending specific organizational changes. As the Center has experienced frequent and significant disruptions from previous reorganizations, the most recent of which occurred within the past year, the committee believes that further changes of location would create additional difficulties.
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From page 101... ...
, 2. Task force report on the National Center for Health Services Research and Development submitted to the Assistant Secretary for Health and Sciencific Affairs, Department of Health, Education, and Welfare, 24 July 1967, p.
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From page 102... ...
, U.S. Department of Health, Education, and Welfare, Public Health Service, Forward Plan for Health, FY 1978-82, DREW Pub.
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