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Beyond Bismarck and Beveridge: towards a research agenda for health systems research.
Delnoij, D. Beyond Bismarck and Beveridge: towards a research agenda for health systems research. European Journal of Public Health: 2003, 13(4 sup.), p. 34. Abstract. 11th Annual Eupha Meeting 'Globalisation and Health in Europe: Harmonising Public Health Practices'. Rome, Italy, 20-22 November 2003.
The aim of this paper is to stimulate debate in the workshop ‘Future directions for health systems research’ by proposing an outline of the field of health systems research, by giving an overview of the literature in this area, and by proposing an agenda for future research in health systems research (HSR). Background: HSR is a multidisciplinary activity. Therefore it disposes of a comprehensive toolkit. The disadvantage is that it does not build on one well-defined theoretical framework. This may lead to misunderstanding of what HSR is about. Methods: The paper is based on a study of the literature and validated in a workshop of an informal group of Dutch researchers, involved in HSR. Results: The types of questions that HSR poses, are: Type 1 questions where health systems are the ‘dependent variable’ (How have health systems developed, how and in what direction do they change?). Type 2 questions where health systems are the ‘independent variable’ (What is the effect of certain institutional structures on the performance of health systems?). Type 1 questions are answered by means of historical analyses, single or multiple (comparative) case studies, relying on a study of the literature, available documentation, and qualitative methods such as interviews with key informants. Type 2 questions are answered through quantitative research in quasi-experimental designs or international comparisons. Conclusion Both Type 1 and Type 2 studies are legitimate branches of HSR that can profit from cross-fertilization. This is particularly true in evaluations of health care reforms, where the sub-domains meet and the type 2 question ‘Which changes in the institutional structure will improve the performance of health systems?’ almost automatically begs the 1 question ‘And how can this change be successfully implemented in the context of a certain health system?’. (aut. ref.)
The aim of this paper is to stimulate debate in the workshop ‘Future directions for health systems research’ by proposing an outline of the field of health systems research, by giving an overview of the literature in this area, and by proposing an agenda for future research in health systems research (HSR). Background: HSR is a multidisciplinary activity. Therefore it disposes of a comprehensive toolkit. The disadvantage is that it does not build on one well-defined theoretical framework. This may lead to misunderstanding of what HSR is about. Methods: The paper is based on a study of the literature and validated in a workshop of an informal group of Dutch researchers, involved in HSR. Results: The types of questions that HSR poses, are: Type 1 questions where health systems are the ‘dependent variable’ (How have health systems developed, how and in what direction do they change?). Type 2 questions where health systems are the ‘independent variable’ (What is the effect of certain institutional structures on the performance of health systems?). Type 1 questions are answered by means of historical analyses, single or multiple (comparative) case studies, relying on a study of the literature, available documentation, and qualitative methods such as interviews with key informants. Type 2 questions are answered through quantitative research in quasi-experimental designs or international comparisons. Conclusion Both Type 1 and Type 2 studies are legitimate branches of HSR that can profit from cross-fertilization. This is particularly true in evaluations of health care reforms, where the sub-domains meet and the type 2 question ‘Which changes in the institutional structure will improve the performance of health systems?’ almost automatically begs the 1 question ‘And how can this change be successfully implemented in the context of a certain health system?’. (aut. ref.)