Health Services Research Report of a Study (1979) / Chapter Skim
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Introduction and Summary of Recommendations
Introduction and Summary of Recommendations
Pages 1-12
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By the mid-1960s, health services research had become a distinct field of inquiry, supported largely by grants and contracts from federal agencies administering the government's health care programs. Recognizing that attainment of national health care objectives and efficient management of the federal government's disparate research activities required a coordinated effort, President Johnson in 1967 ordered the creation of the National Center for Health Services Research and Development within the Department of Health, Education, and Welfare.
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Moreover, the growth of research in health services throughout the federal government has occasioned concern about the necessity for continuing the National Center for Health Services Research, and possibly wasteful duplication and fragmentation of research efforts.~2] In view of these concerns, the Office of Science and Technology Policy of the Office of the President of the United States in September 1977 commissioned the Institute of Medicine to undertake an assessment of the field of health services research for the purpose of proposing recommendations that would clarify the focuses and boundaries of the field and improve its contributions to decisions affecting health care.
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Nevertheless, it is evident that on several issues, such as health maintenance organizations, hospital bed supply, and increases in health care expenditures, research findings have influenced both the level and focuses of debate. Health services research within the federal government can produce findings that frequently have political implications.
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Its emphasis on some agencies, particularly the National Center for Health Services Research, reflects the committee's recognition of their primary importance in the federal government's health services research structure. Finally, the committee did not attempt to weigh the contributions of health services research in all issues of health care delivery or to set forth research agendas for them.
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For those agencies which conducted or supported health services research, the questioning extended to the methods by which research priorities are established, mechanisms for assuring the quality of research, and relationships with other agencies engaged in health services research, especially the National Center for Health Services Research and the Health Care Financing Administration. Information assembled by staff was summarized in memoranda that were distributed to committee members.
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Therefore, the committee recommends that attempts to coordinate health services research _ within the federal government should not centralize responsibility for the conduct or sponsorship of research required for the attainment of specific and identifiable program or agency objectives. This recommendation has two implications.
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Rather, a strategy of funding should be developed that identifies the strengths and problems associated with each and achieves a balance among them. From its review of the history of the National Center for Health Services Research, the Center's current priorities and functions, and potential for effecting greater coordination of the health services research activities of the Public Health Service, the committee recommends that the National Center for Health Services Research be maintained as a general-purpose health services research agency within the federal government.
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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.
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In view of the limited funds available to support investigator-initiated health services research, the committee recommends that legislation authorizing the National Center for Health Services Research be amended to strike the requirement that the Center support centers for health services research. ~ _ The National Center should be petted to support center grants if a consensus is reached that the program complements the Center's overall mission and the evolution of the field as a whole.
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The legislative requirement that at least a one-quarter of the Center's budget be devoted to intramural research means that extremely limited resources are channeled to intramural efforts that might be spent more wisely on investigatorinitiated extramural research. In view of the stringent fiscal and personnel constraints faced by the National Center for Health Services Research, the committee recommends that the legislation mandating the intramural research program of the National Center for Health Services Research be amended to strike the language requiring the Center to allocate not less than twenty-five percent of its budget to intramural research.
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Therefore, the committee recommends that the National Center for Health Services . Research remain in its present location in the Office of the Assistant Secretary for Health and that the effects of these arrangements on the various functions and priorities of the Center be evaluated after a suitable interval, say five years, to determine whether further reorganiza, Lion is warranted.
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121-32; Charles E Lewis, "Health Services Research and Innovations in Health Care Delivery: Does Research Make a Difference?
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