Health Services Research
“Of 1000 patients to the best physicians, aged of any decade, do not as many die as out of the inhabitants of places where there dwell no physicians?”
–Sir William Petty (1623-1687), A father of health services research
The Institute of Medicine of the U.S. National Academy of Sciences has estimated that medical errors account for as many as 98,000 hospital deaths annually. Huge, unexplained variations exist within and among nations in the rates, outcomes, and costs of many common medical interventions. Health services research focuses on these matters using the concepts and methods of epidemiology, economics, statistics, and the social and behavioral sciences to examine and assess medical interventions. Key components of health services research include:
- Clinical Epidemiology
- Evaluative Health Sciences
- Evidenced Based Medicine
- Health Economics
- Health Policy Research
- Healthcare Research
- Medical Care Research
- Outcomes Research
- Patient Care Research
- Population Health Research
Starting in the latter half of the 20th century, the data has gradually become more accurate and abundant and the analytical methods more sophisticated. The underlying question that drives health services research is “Compared to what?” Does the proposed intervention, technology or service increase the benefit, reduce the risk or lower the cost over current practices, equipment or processes?
In 1968, at White’s instigation, the National Center for Health Services was created (now called the Agency for Health Care Research and Quality), and has helped to increase federal financing to research health services. This field has grown so much that virtually all medical and public health schools have departments that conduct health services research.
The intrinsic power of health services research has provoked attacks by clinical specialty associations as well as pharmaceutical and equipment companies whose interventions were found to be useless or harmful. Gradually, scientifically organized comparison has become the gold standard for adopting new health policies, procedures, and practices. The road ahead is challenging but full of opportunities. Health services research is a worthy companion to biomedical research in improving individual and collective health.