Field Of Health Services Research Research Articles

DFG-Nachwuchsakademie Versorgungsforschung –Konzept – Ablauf - Teilnehmerrückmeldungen

In December 2010, the Institutes for Social Medicine and Cancer Epidemiology of the University of Lübeck hosted the first Workshop for Early Career Investigators in the area of Health Services Research. This workshop was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) with the aim to promote young scientists and researchers that wish to pursue research in the field of Health Services Research in an early phase of their career. The following report addresses the background, concept and progress of the initiative. All applicants had to submit a detailed project proposal and underwent a rigorous selection process. The projects presented at the workshop covered a wide range of topics, such as, for example, access to health care, common elements of mental illnesses and psychosomatic disorders, quality assurance in medical practices (i.e., evaluation of disease management programmes) and targets in rehabilitation. A major subject was migration as a challenge to Health Services Research. The 20 best applicants out of 121 were invited to attend the programme. During five days the participants had the opportunity to present their projects and discuss current issues as well as fundamental themes in study design. At the same time, national and international leading experts gave a series of lectures on current topics of Health Services Research. In numerous discussion groups and topical workshops participants and speakers explored and sought solutions to specific research issues. Following the programme participants are expected to finalise their research proposals and apply for funding to the DFG. To foster networking among early-career researchers, an alumni meeting is scheduled after 12 months. The DFG Workshop for Early Career Investigators was the first of its kind in the field of Health Services Research in Germany. However, evidence of its sustainability will have to be obtained from the future development of the German Health Services Research.

Paradigms, pragmatism and possibilities: mixed‐methods research in speech and language therapy

After the decades of the so-called 'paradigm wars' in social science research methodology and the controversy about the relative place and value of quantitative and qualitative research methodologies, 'paradigm peace' appears to have now been declared. This has come about as many researchers have begun to take a 'pragmatic' approach in the selection of research methodology, choosing the methodology best suited to answering the research question rather than conforming to a methodological orthodoxy. With the differences in the philosophical underpinnings of the two traditions set to one side, an increasing awareness, and valuing, of the 'mixed-methods' approach to research is now present in the fields of social, educational and health research. To explore what is meant by mixed-methods research and the ways in which quantitative and qualitative methodologies and methods can be combined and integrated, particularly in the broad field of health services research and the narrower one of speech and language therapy. The paper discusses the ways in which methodological approaches have already been combined and integrated in health services research and speech and language therapy, highlighting the suitability of mixed-methods research for answering the typically multifaceted questions arising from the provision of complex interventions. The challenges of combining and integrating quantitative and qualitative methods and the barriers to the adoption of mixed-methods approaches are also considered. The questions about healthcare, as it is being provided in the 21st century, calls for a range of methodological approaches. This is particularly the case for human communication and its disorders, where mixed-methods research offers a wealth of possibilities. In turn, speech and language therapy research should be able to contribute substantively to the future development of mixed-methods research.

Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients

BackgroundThe effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP) at the primary health care (PHC) level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a) to gain an in-depth understanding of general practitioners' (GPs) and patients' perceptions about HPP in PHC, and b) to define the areas that could be improved in future interventions.MethodsQualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise). Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers.ResultsGPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere.ConclusionsHPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients' social micro-contexts. On the basis of the explanatory framework, three development lines are proposed: the incorporation of new methodological approaches according to the complexity of HPP in PHC; the openness of habit change policies beyond the medical services; and the effective commitments in the medium to long term by the health services themselves at the policy management level.

Memorandum III: Methoden für die Versorgungsforschung (Teil 2)

The methodical quality of health services research studies is often subject to criticism. Common standards in the field of health services research have been lacking so far. Hence, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] decided to contribute to an improvement of this situation. The DNVF e. V. has already published part 1 of the Memorandum III"Methods for Health Services Research" for the 3 subject areas "Epidemiological Methods for Health Services Research", "Methods for Organisational Health Services Research" and "Methods for Quality of Life Research". The herewith published Part 2 of the Memorandum extends the spectrum by describing the methodological principles and minimum standards of "Methods of Health Economic Evaluations" and "Registries for Health Services Research". On 30 (th) August 2010, the member societies, mentioned as authors, approved this second part of the Memorandum III. 2 in-depth publications focussing on the 2 mentioned topics will be published in the next issues of this journal. This memorandum is intended for health services researchers who are planning, conducting and publishing studies as well as for reviewers who evaluate research proposals and publications on health services research studies. In accord with the expected advances in knowledge in health services research, it is planned to update the 2 parts of Memorandum III at appropriate intervals and to publish further parts from the huge spectrum of methods relevant to this field in the near future. Thus, the Memorandum has to be considered as work in progress.

Fractured neck of femur--internal fixation versus arthroplasty.

Surgery is the treatment of choice for fractured neck of femur. For middle-aged patients (aged ca. 40 to 65), there is considerable debate over the indications for arthroplasty or internal fixation. The choice of surgical technique varies widely from one region to another. In this article, we discuss the main criteria that should be used in making this decision. We selectively reviewed the literature on the diagnosis and treatment of fractured neck of femur, including the current guideline of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU) and recent findings from the field of health services research. The treatment of middle-aged patients with dislocated fractures should be based on rational decision-making. The patient's level of activity before the accident should be judged in terms of his or her previous mobility, independence in daily activities, and mental status. Internal fixation is recommended if the fracture can be adequately repositioned, the bone is of good quality, and there is no evidence of osteoarthritis. Fractures that are more than 24 hours old should be treated with total hip arthroplasty. Hemiprostheses are appropriate for very old patients. Physically frail, bedridden, and/or demented patients should undergo internal fixation of the fracture. For non-displaced or impacted fractures, functional treatment (i.e., prophylactic securing of the fracture with screws or nails) is indicated. Rapid diagnosis and a short time in bed before surgery lower the rate of complications. Internal fixation with preservation of the femoral head should ideally be performed within the first 6 hours of trauma, and within the first 24 hours at most. Despite the increasing scarcity of resources, treatment should still be based on well-founded clinical guidelines. Minimally invasive surgery enables better function in the early postoperative phase and can thereby lower complication rates. An interdisciplinary concept for the postoperative care of elderly patients also has a major effect on the outcome.

A Report from The Coalition for Health Services Research: “Health Reform: What It Means for Health Services Research”

Health Services ResearchVolume 45, Issue 3 p. ix-xxi A Report from The Coalition for Health Services Research: “Health Reform: What It Means for Health Services Research” First published: 03 May 2010 https://doi.org/10.1111/j.1475-6773.2010.01121.x Editor's note: Health Services Research (HSR) invited the publication of this document as a part of its commitment to work with AcademyHealth (AH), the professional society for health services research and health policy, to provide health services researchers with important updates from AH. While we recognize that The Patient Protection and Affordable Care Act is subject to modification (as is any law), due to changes in statute and its interpretation, we believe that it is important to inform researchers about key provisions of this law that may impact our field. The document and accompanying analysis were prepared in late March 2010 for The Coalition for Health Services Research, the advocacy arm of AH, by its consultant, Emily J. Holubowich, of Cavarocchi Ruscio Dennis Associates LLC. It is intended as an analysis of the likely impact of the Patient Protection and Affordable Care Act (P.L. 111–152) as signed into law by President Obama on March 23, 2010, summarizing only provisions anticipated to directly and significantly impact the field of health services research. The views and interpretations do not necessarily represent those of HSR or AH. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume45, Issue3June 2010Pages ix-xxi RelatedInformation

Reflections in Honor of the Contributions of Harold S. Luft: Overview of the Occasion

Reflections in Honor of the Contributions of Harold S. Luft: Overview of the Occasion

Finally, a consensus statement on sickle cell disease manifestations: A critical step in improving the medical care and research agenda for individuals with sickle cell disease

Finally, a consensus statement on sickle cell disease manifestations: A critical step in improving the medical care and research agenda for individuals with sickle cell disease

The Health Services Research Workforce: Current Stock

To examine the size and characteristics of the health services research (HSR) workforce; the job satisfaction, job security, and future plans reported by the workforce; and the future of the HSR workforce supply. (1) AcademyHealth active and lapsed members since 2000 and annual research meeting presenters and interest group participants; (2) principal investigators of research projects listed in the HSRProj database; and (3) authors of articles published in two HSR journals. Data on investigators conducting HSR in selected venues were collected and compared in order to identify the percentage of the HSR workforce represented in the "core" versus related disciplines and to investigate the extent to which the "core" researchers publish, present, or participate in disciplinary venues. The field appears to have grown dramatically since 1995, from an estimated 5,000 health services researchers to an estimated 11,596 in 2007. This is a broad workforce characterized by various levels of involvement in the field. Some researchers self-identify with the field of HSR, while others are associated primarily with venues related to specific disciplines. Many researchers who identify with HSR also publish in venues related to multiple other disciplines. The field may face future challenges related to demographic change, such as an aging workforce and an increased need for diversity. International collaboration appears common, and in the future the field may need to be defined internationally rather than nationally. At the same time, there are also many indications that HSR is a good field to work in. Health services researchers reported high levels of satisfaction with their profession and current employer, as well as little desire to change jobs and little concern about job security.

Applying Health Services Research to Public Health Practice: An Emerging Priority

Achieving an effective, efficient, and equitable health system has proven to be an elusive goal for health policy makers in the United States, but the field of health services research (HSR) has become increasingly central in charting the path toward this destination. HSR has evolved in tandem with the information needs of decision makers in government and the private sector, from perennial interests in coverage and cost containment to more recent concerns about quality, safety, and health disparities. Over much of this history, the producers and users of health services research have focused heavily on the production and consumption of medical care, while giving comparatively little attention to another important component of the health system—that of public health services. These services include population-wide efforts to identify and investigate health threats, promote healthy lifestyles, prevent disease and injury, prepare for emergencies and disasters, and assure the quality of water, food, air, and other resources that affect human health (Institute of Medicine, Committee for the Study of the Future of Public Health 1988). The relative paucity of studies on this aspect of health system performance reflects the relatively low priority given to public health practice during the last half of the 20th century. In recent years, public health has undergone a notable resurgence in visibility among both policy makers and the public at large. Concerns about gaps in the availability and quality of public health services have grown rapidly in response to both new and persistent health risks, including infectious diseases like SARS and pandemic influenza, the threat of bioterrorism, natural disasters like the 2005 Gulf hurricanes, and the rapid advance of obesity and preventable chronic diseases. Since 2001, the federal government has invested >$10 billion in new funds to support public health activities, with a primary focus on helping communities prepare for and respond to large-scale public health emergencies (Trust for America's Health 2006). The increased attention and resources have generated expanded interest in using the concepts and methods of health services research to develop better ways of organizing, financing, and delivering public health services. This emerging focal point within health services research has become known as public health services and systems research (Mays, Halverson, and Scutchfield 2003; Scutchfield et al. 2007;).

Memorandum III: Methoden für die Versorgungsforschung (Teil I)

The methodical quality of health services research studies is often subject to criticism. Common standards in the field of health services research have been lacking so far. Hence, the German Network Health Services Research [Deutsches Netzwerk Versorgungsforschung e.V. (DNVF e.V.)] decided to contribute to improve this situation. On 1 July 2009, the DNVF e.V. approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors. For the three subject areas "Epidemiological Methods for Health Services Research", "Methods for Organisational Health Services Research" and "Methods for Quality of Life Research", this Memorandum describes the methodological principles and minimum standards which should be adhered to when conducting and publishing health services research studies. Three in-depth publications focussing on the three mentioned topics will be published in the next issues of this journal. This memorandum is intended for health services researchers who are planning, conducting and publishing studies as well as for reviewers who evaluate research proposals and publications on health services research studies. In accord with the expected advances in knowledge in health services research, it is planned to update the Memorandum III (part 1) at appropriate intervals and to publish part 2 in the near future. Thus, the Memorandum has to be considered as work in progress.

Interview with a Quality Leader—Karen Davis, Executive Director of The Commonwealth Fund

Karen Davis is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues. Dr. Davis is a nationally recognized economist, with a distinguished career in public policy and research. Before joining the Fund, she served as chairman of the Department of Health Policy and Management at The Johns Hopkins School of Public Health, where she also held an appointment as professor of economics. She served as deputy assistant secretary for health policy in the Department of Health and Human Services from 1977 to 1980, and was the first woman to head a U.S. Public Health Service agency. Before her government career, Ms. Davis was a senior fellow at the Brookings Institution in Washington, DC; a visiting lecturer at Harvard University; and an assistant professor of economics at Rice University. A native of Oklahoma, she received her PhD in economics from Rice University, which recognized her achievements with a Distinguished Alumna Award in 1991. Ms. Davis is the recipient of the 2000 Baxter-Allegiance Foundation Prize for Health Services Research. In the spring of 2001, Ms. Davis received an honorary doctorate in human letters from John Hopkins University. In 2006, she was selected for the Academy Health Distinguished Investigator Award for significant and lasting contributions to the field of health services research in addition to the Picker Award for Excellence in the Advancement of Patient Centered Care. Ms. Davis has published a number of significant books, monographs, and articles on health and social policy issues, including the landmark books HealthCare Cost Containment, Medicare Policy, National Health Insurance: Benefits, Costs, and Consequences, and Health and the War on Poverty. She serves on the Board of Visitors of Columbia University, School of Nursing, and is on the Board of Directors of the Geisinger Health System. She was elected to the Institute of Medicine (IOM) in 1975; has served two terms on the IOM governing Council (1986-90 and 1997-2000); was a member of the IOM Committee on Redesigning Health Insurance Benefits, Payment and Performance Improvement Programs; and was awarded the Adam Yarmolinsky medal in 2007 for her contributions to the mission of the Institute of Medicine. She is a past president of the Academy Health (formerly AHSRHP) and an Academy Health distinguished fellow, a member of the Kaiser Commission on Medicaid and the Uninsured, and a former member of the Agency for Healthcare Quality and Research National Advisory Committee. She also serves on the Panel of Health Advisors for the Congressional Budget Office.

Variabilidad, efectividad y desigualdad: histerectomías y prostatectomías por enfermedad neoplásica en España (2002-2004)

Debates about equity in the utilization of health services often omit whether inequalities are observed in effective and safe procedures or they are experienced in treatments dubiously effective. This work tries to illustrate the difference between inequality and inequity in the health services research field. Ecologic study on the standardized rates of surgical interventions in uterus and prostate cancer, produced between 2002 and 2004 in 180 healthcare areas in Spain. Socioeconomic variables: public beds per 100,000 inh, economic level, unemployment rate (population between 25 and 49), bank offices per 1,000 inh., and proportion of illiterate or persons with no studies. To estimate inequality statistics for Small Area Analysis were used; to determine the effect of socioeconomic factors, ANOVA and Linear Multiple Regression were modelled. 12,178 admissions for hysterectomy (2.19 per 10,000 women) and 13,416 prostatectomies (2.47 per 10,000 men) were analysed. All the statistics showed higher variation (inequality) in prostate cancer. Hysterectomy rates were not related with socioeconomic factors as oppose as prostatectomy: higher rates were related with living in areas with bigger centres (beta=0.89, p <0.001), with more economic level (beta=0.72, p=0.004) and less rate of illiterate persons (with regard to the tertile, betat2 = 0.75, p=0,002; betat3 = 0.57, p=0,044). Inequalities in the utilization of healthcare services do not necessarily imply inequity. In prostatectomy due to prostate cancer, an uncertain procedure in terms of effectiveness, the observed inequalities against poorer areas, should not be interpreted as a symptom of inequity.

Challenging Our Comfort Levels: Lifestyles, Research, and the Ongoing Legacy of the Robert Wood Johnson Foundation

Life unfolds as a series of nonlinear biological and environmental interactions mediated through semi-permeable membranes. Complexity is its character. Research is designed as carefully crafted observations filtered through semi-artificial controls. Simplicity is its aim. The tension is clear and the consequence can be limiting. Science startles when it finds power in singularity, but it matures when it reveals the nature and impact of multiplicity. Both as individuals and as scientists, patterns of behavior to which the dominant incentives have been directed over the past half century have left us sluggish in our lifestyles and constrained in the reach of our research. Ten years ago, the Robert Wood Johnson Foundation (RWJF) set out to change this. As an expression of the overall population health strategy of the Foundation, the Active Living family of programs has challenged us not only to greater motion in our lifestyles but to greater ambition in our research endeavors—to look directly and creatively at concepts, issues, and approaches most central to fostering broad health findings and gains. Informed by a generation of insights establishing that health is determined neither by fate nor by accident, but by the intersecting dynamics within and among five domains of influence—genetic predispositions, social circumstances, physical environments, behavioral choices, and medical care 1 —the Foundation committed to building the field of population health. Its aim was to contribute to population health science much as it had contributed over the previous quarter century to growing the field of health services research. The Foundation had important experience on which to build. In the face of the devastating impact of substance abuse on the lives and health of certain populations, it had begun in the late 1980s to combat drug and alcohol abuse, and it expanded its focus during the 1990s with a major commitment to fight tobacco as the nation’s leading single cause of preventable death. In 1999, RWJF decided to devote half of its resources to prevention and population health. Two new Foundation initiatives—on population health science and on physical activity—were established to complement its strong leadership to counter substance abuse and to strengthen front-line community capacity for behavioral and social interventions important to health. The population health science initiative was designed to serve as an incubator for the training, leadership, and research necessary to advance the frontiers of the field. Along with the launching of a variety of creative projects, its two flagship efforts are the Health & Society Scholars (H&SS) program and the Young Epidemiology Scholars (YES) program. H&SS is a 2-year post-doctoral program intended to attract the nation’s most promising minds to interdisciplinary collaboration in health research. YES is a regional and national competition introducing and encouraging our brightest high school students to become interested and engaged in projects in epidemiology as the basic science of population health. Both are aimed at creating the first generation of scientific and program

Knowledge Transfer in Mental Health Care: How Do We Bring Evidence into Day-to-Day Practice?

While our knowledge about effective (mental health) care is growing fast, transfer of this knowledge to practice and use in day-to-day patient care is often failing. Scientific evidence is increasingly summarized in systematic reviews (for example, by international Cochrane Collaboration working groups) and in clinical practice guidelines (thousands of guidelines are available around the globe). However, audits in different countries show that as many as 30% to 45% of patients fail to benefit fully from this development because they do not receive optimal (evidence-based) treatment.1-3 A large percentage of medications and tests administered to patients are unnecessary (estimated at 20% to 25%), and therefore costly and potentially harmful for patients. Transfer of scientific knowledge on appropriate performance in mental health care meets similar problems; for example, only one-quarter of patients with anxiety disorders in the United States received care in line with evidence-based treatment guidelines.4 A study5 in the Netherlands on patients with symptoms of depression showed both substantial over- and undertreatment with antidepressants. Widespread implementation of evidence-based care models for patients with severe mental illness failed until recently.6,7 In conclusion, concerning knowledge transfer to health care practice, we are dealing with a large and underestimated problem. Focused attention to the problem, and articles about possible ways forward in mental health care as presented in this issue,8,9 is an important step to explore and find solutions. The question of how to bring scientific knowledge more effectively into day-to-day practice is not an easy one to answer. Many policy-makers and practitioners have naive ideas about implementation of better mental health care. For instance, many have the expectation that if scientific knowledge is presented to mental health professionals in accessible formats with convincing arguments for their use that they will use it in practice. Some professionals will indeed do so, but most are influenced, most of the time, much more by other drivers, such as practical problems, organizational barriers, patients demands, avoiding unrest and conflict in their work setting, financial incentives, opinion of peers, and the wish to have a good time. This makes knowledge transfer, also in mental health care, a complex issue without straightforward answers. Overviews of the literature on effective knowledge transfer and implementation of evidence into practice (for example, Grol and Grimshaw,10 Grimshaw et al,11 and Grol et al, editors)12 showed that many different approaches and interventions to implement evidence into practice are used, some focusing on knowledge, attitudes, or routines of individual professionals (for instance, courses, conferences, feedback, reminders, outreach visitors, and opinion leaders), others on: influencing patient behaviour or patient demands to professionals; organizational changes to promote better use of evidence; or, economic or regulatory interventions to enforce following clinical guidelines. None of these approaches proved to be superior in all settings or for all problems, and even well-developed change programs had mostly only moderate effect (8% to 10% change in key targets). For many new types of change interventions (such as the breakthrough collaborative model, pay-for-performance initiatives, leadership enhancement, and patient empowerment), the number of well-designed studies is very limited. It becomes clear from these overviews that different health problems and guidelines, and different health care settings, may need their own exploration of what would work to improve patient care. This is clearly shown in the 2 reviews of change interventions in this issue: one focusing on anxiety problems in primary and ambulatory (mental health) practice,8 the other on severe mental health problems both in in-hospital and in community settings.9 These are important papers from a new field of health services research (quality improvement research) that has become adult in recent years, for instance by the work of the Cochrane Center for Effective Practice and Organisation of Care. …

Studien zur Versorgungsforschung. Eine Hilfe zur kritischen Rezeption

Proponents of evidence-based medicine have developed a framework for the critical appraisal of clinical studies. Though this framework is generally accepted, a universal standard for health services research is not yet available. While clinical research evaluates the efficacy and effectiveness of medical interventions, the remit of health services research is to investigate the actual delivery of care in a given health care system. Here, we propose six criteria for the critical appraisal of work published in the field of health services research: the research question, the validity of the study design, the indicators used, the data source, the audience being addressed and the interests behind a study should all be considered when discussing health services research studies. Ideally, health services research should be an integral part of research efforts including basic as well as clinical research.

Health services research in dermatology – current update and perspectives

An in-depth knowledge of the demands on health care resources and the quality of health care provision is of major importance for the future care of skin and allergy patients. We present a comprehensive summary of all available health care data and research activities in dermatology in Germany. A standardized electronic literature search was performed using PUBMED as well as a manual search to identify activities in the field of health services research in dermatology. Furthermore, questionnaires were sent to 114 dermatology hospitals and to 52 health service research institutions in Germany. The overall return rate of the survey was 81%. Hints on projects were given by 30 hospitals and 5 institutions. Most of these projects were in the field of epidemiology, quality of life, economy and prevention. Finally, the search identified 101 health services research projects in Germany. In addition, material gathered from internet and secondary citations from scientific journals produced a total of 216 publications. Only few projects were found on the working conditions of physicians and other health care professionals, on the implementation of guidelines, on needs and use of dermatological services and on the quality of care. The findings demonstrate that there are substantial deficiencies in some important areas of health services research in dermatology. To provide efficient and qualified dermatological health care in Germany in the future, more research projects on the needs, demands and quality of health care are needed.

From the Editors: Announcing a New Feature in HSR and a Call for Papers

Health Services ResearchVolume 42, Issue 3p1 p. 929-932 From the Editors: Announcing a New Feature in HSR and a Call for Papers Ann Barry Flood, Ann Barry FloodSearch for more papers by this authorJosé J. Escarce, José J. EscarceSearch for more papers by this author Ann Barry Flood, Ann Barry FloodSearch for more papers by this authorJosé J. Escarce, José J. EscarceSearch for more papers by this author First published: 02 May 2007 https://doi.org/10.1111/j.1475-6773.2007.00737.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume42, Issue3p1June 2007Pages 929-932 RelatedInformation

Prospective Payment: Medicare’s Secret Success Story

Despite its rich intellectual foundations, the health services research field often seems blind to history and naively susceptible to faith-based conventional wisdom. In their new study of Medicare prospective payment, Rick Mayes and Bob Berenson throw off both of these limitations, with illuminating results. Although managed care is widely regarded in policy circles as a noble victory for employers and insurers in the struggle for control of health spending, Mayes and Berenson contend that “the private sector neither initiated this battle nor provided the critical innovation that transformed health care in the United States.” This slender volume offers value on several dimensions. First, it is an explication of recent history that connects the dots from prospective payment to Medicare-based deficit reduction to cost shifting to managed care. By the same token, the story here serves as a bracing corrective to the mythology of market-based reform and the assumption that government’s role in health is inescapably a negative one. Further, policy scholars will relish the intimately detailed examination of the process by which research and ideas are translated into practice, amid all of the unpredictability of politics and circumstance. It is also a readable saga of the life and times of a generation of thinkers and actors who are still among us and who are still riding the train of events set in motion by enactment of the prospective payment system (PPS) in 1983. Text and notes are loaded with colorful recollections and ruminations of former whiz kids who grew older and wiser as the fruits of their labor ripened. Finally, the PPS story is a sobering object lesson in how sharply policy making by disinterested professionals may contrast with the kind of politically and ideologically driven strategy and legislation that is characteristic of the current era. The backstory here, it will be remembered, is that analysts and policymakers recognized in the early 1980s that cost-based provider reimbursement, which Medicare had cloned from the traditional Blue plans, was fueling runaway inflation in health care. Researchers had been tinkering with diagnosis-based reimbursement schemes for years at this point, and notwithstanding the fact that such “administered prices” were anathema to conservative economists, diagnosis-related groups (DRGs) looked like the right fix to officials in Congress and the Reagan administration. “We just pulled them off the shelf,” said Don Moran, then in the Office of Management and Budget. In the heat of the moment, debate was minimal, and details were left to the experts. First-order effects were resoundingly successful. Medicare hospital payment growth dropped from 16.2 percent a year in 1980–83 to 6.5 percent in 1984–87, while hospitals’ financial health improved with increases in efficiency, and patient outcomes showed no discernible damage. Mayes and Berenson explore a panoply of more-nuanced effects, but the mother of unintended consequences in their history is Congress’s eventual discovery that the annual DRG update factor could be a very

What do you do for a living? Toward a more succinct definition of health services research

This commentary discusses the need for, and the advantages of, a more concise, revised definition of the field of health services research. It argues for a definition that includes not only the topics on which health services research focuses but also the goals of health services research. A number of condensed definitions are provided for consideration.