Personnel Needs and Training for Biomedical and Behavioral Research 1983 Report (1983) / Chapter Skim
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5. Health Services Research
5. Health Services Research
Pages 117-130
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From page 117... ...
Clearly, the goals, practices, and efficiency of governmental health activities are both a national economic issue of high importance and a major determinant of the quality and availability of health care. iAll figures in this section are from the U.S.
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From page 118... ...
It includes such significant fields of inquiry as the definition and determinants of the effectiveness and efficiency of prepaid medical care plans, various approaches to health insurance, health maintenance organizations and group practice, the role and scope of primary care, the assignment of patient care tasks to various health professionals, the efficiency of hospital operations, and nursing delivery systems. A sense of the breadth of the field and the multiplicity of approaches can be provided by describing a few of these important areas of investigation.
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From page 119... ...
Although the meaning of the findings for health policies was interpreted differently by different interests, the validity and relevance of the study for health services delivery decision making were generally accepted by all. The study contributed vital information to the current debates over national health insurance and other large-scale health policy measures.
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From page 120... ...
The problem areas include: Health Personnel, Mental Health Personnel, Ambulatory Care, Child Health Services, Dental Health Services, Emergency Health Services, Indian Health Services, Long-term Care, Nursing Health Services, Pharmacy-related Health Services, Rural Health Care Services, Mental Health Services, Drug Abuse Prevention Programs, Alcoholism Prevention Programs, Access and Equity of Health Services, Inflation and Cost Containment, Health Insurance, Quality Assurance, Legal Aspects of Health Care, Health Politics, Community Studies, Health Education, Sociobehavioral Aspects of Health Care, Health Services Design and Development (including technology transfer)
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From page 121... ...
The second set of qualifications is an understanding of some aspects of the delivery and financing of health care and a mastery of suitable research methods. Included are such areas as quantitative measurement of access to health care by various socioeconomic groups, means of assessing the quad ity of health care, medical care ethics and the law, the technical aspects of cost reimbursement, the politics of health care, management of health care delivery organizations and the administration of prepayment and health insurance plans.
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From page 122... ...
This evolution of educational patterns towards specialized HSR training added to earlier disciplinary training has produced two kinds of health service researchers. "One, principal investigators, is older, almost exclusively men (91 percent)
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From page 123... ...
It should be emphasized that the Committee was unable to find sufficient data to better estimate the current supply of health services researchers, much less to develop reasonable quantitative estimates of future demand. In this sense the situation in hey th services research is very different from the biomedical, behavioral, and clinical sciences discussed earlier.
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From page 124... ...
It follows that most graduate students in the field are self-supported with funds derived from their own or their spouses wages or savings, loans, or in relatively rare instances, family support. These observations are based upon the impressions of program directors since no survey of sources of support for graduate students in this field has been conducted.
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From page 125... ...
The decline in federal support for health services research is attributable to such factors as the diversity of the field, the fact that performers and users of health services research have not presented a strongly unified case for the utility of the product, the absence of strong support for general health services research among the federal agencies with major health responsibilities, concentration on short rather than long-range issues, and the general downward pressure on federal expenditures. Looking at the federal agencies as a whole, the short-run outlook is for level funding, or perhaps very modest increases, for directly budgeted HSR funds.
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From page 126... ...
Indirect Funds A small but unknown fraction of the Medicaid and Medicare funds will be spent for the managerial type of health services research. These funds will provide increasing amounts for research bearing upon the operating efficiency of health care delivery organizations.
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From page 127... ...
State and Local Support, and Funds from Private In(lustry While most state and local expenditures for health services research are derived from federal sources and are hence accounted for in direct and indirect federal expenditures, some funds are generated locally. The rapidly growing private hospital industry has a health services research component which will probably grow as the industry expands.
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From page 128... ...
A second component of the university system for health services research is a set of organized programs or centers associated in varicus ways with universities.6 While some university-based health services centers are being supported in a fashion that virtue lly assures a high level of research and training productivity for several years into the future, this is not true of enough centers to give the nation a vigorous, healthy, stand-by system. The financial problems of virtue lly all universities are inhibiting their ability to provide stable institutional support for research centers of all kinds.
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From page 129... ...
There may well be wider recognition of the need to provide a firmer conceptual and factmL base for the inevitable debates over social goals, over the equity of access to medical care, over the quality of medical care, and over differential impacts on socioeconomic groups. Continuing increases in the costs of medical care could generate an intensified program of research on cost containment by both public and private organizations.
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From page 130... ...
Whether there is a need for special added efforts to strengthen the research and training capacity of some or all of the centers and the forms which this support might take cannot be soundly determined in the absence of such a review. Accordingly, the Committee suggests that a meeting be convened under the auspices of the National Academy of Sciences of major interested parties -- such as federal officials, leading investigators, some center directors, and officials of private foundations -- to explore such matters as the goats and content of a review, of strengths and weaknesses of HER centers, the definition of a center, criteria for selecting centers for support, the structure and auspices for a study, and financing .7 7 The Institute of Medicine report, HeaLth Services Research (1979)
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