Health systems research

from Wikipedia, the free encyclopedia

Health system research aims to create new knowledge by describing, analyzing and evaluating the relationships between health, health care, society and the environment in this branch of health sciences . On this basis, it advises health policy and enables societies to improve health.

System, health system and health research

A system is a goal-oriented, organized, dynamically interacting connection of components in which there are various causes and effects and desired and undesired side effects. Individual and common behavior, cultural influences, organized interventions, ecological and economic framework conditions, historical experiences and much more have their influence on these relationships. Against this complex background, systems research tries to understand, compare, evaluate and change systems in general and health systems in particular.

The main components of the health system - health, healthcare, society, the environment - are interrelated. Examples:

  • Healthcare is supposed to improve health, but it can also damage it through false-positive diagnoses or hospital infections.
  • Healthcare is an important economic and social sector that creates work and income, but can also damage societies due to a lack of profitability.
  • Health is threatened by natural pathogens but also by social and economic influences such as unemployment, poverty, crises and wars.
  • The health system is affected by the effects of the environment and nature - e.g. B. Infections, climate, nutrition - facing ever new challenges.

For these exemplary reasons, it is necessary to analyze the entire health system and not just the health-care relationship.

When the World Health Organization (WHO) was founded in 1946, health was defined as “a state of complete physical, mental and social well-being, not just the absence of illness or ailment”. Medical care and the organization of the health system are not sufficient for this. Health has been interpreted further since the 1980s. It is about people "having at least such a state of health that they are able to work productively and actively participate in the social life of the community".

Health research

The 1986 Ottawa Charter of the WHO on health promotion refers to various factors that are necessary for this: “The basic conditions and constituent elements of health are peace, adequate housing, education, nutrition, income, a stable eco-system, and careful use of existing natural resources , social justice and equal opportunities. Every improvement in the state of health is inevitably tied to these basic requirements. ”The Nobel laureate in economics, Amartya Sen, expanded this perspective and sees health in the context of a capability for freedom and liberation.

Health research examines what hinders or creates, protects, supports and promotes health in this broad sense and what causes, recognizes, heals, reduces, alleviates and prevents diseases. Health systems research includes "all health services research , most health policy research, some clinical research and research on the health of populations, but not biomedical research".

Development of health system research in Germany

After the misuse of the terms social medicine and social hygiene by the racial hygiene of the Nazi regime, health sciences in Germany were in a state of shock for a long time. In addition to biomedical and clinical research on diseases, a research landscape on health was only hesitantly developed. Health systems research emerged in the 1970s, at a time when other new branches of science such as cybernetics , operations research and systems research were trying to establish themselves .

Impetus and precursors

The International Institute for Applied Systems Analysis (IIASA), founded in Vienna in 1972, was a unique collaboration between Western Europe, the Soviet Union and the United States of America at the time. Since 1973 it designed and disseminated the idea of systems analysis in health care, which was initially shaped by Soviet researchers.

Even critical medicine in Germany was committed to a systems analysis of the health system as early as 1973.

At the same time, institutes for applied health research were established in Germany , which were active in the health care system on behalf of and for the account of self-government agencies:

  • In 1973 the Central Institute for Statutory Health Insurance (ZI) was founded in Cologne. It researched and advised on behalf of the outpatient statutory health insurance physicians. Friedrich Wilhelm Schwartz shaped this institute. He is considered the Nestor of Public Health in Germany.
  • In 1975 Fritz Beske founded the Institute for Health System Research Kiel (IGSF). His first focus was regional health care in Schleswig-Holstein and then worked for many other clients. Fritz Beske is the grand seigneur and still a trend-setting mentor for health system research in Germany.
  • In 1976, the Scientific Institute of Local Health Insurance Funds (WIdO) was established in Bonn under the direction of Ulrich Geißler.

These institutes shaped and continue to shape applied health research in the German health system. However, they are not active in the public interest, but in the interests of their clients.

The beginning of health system research in Germany

The suggestions of the IIASA were mainly taken up by Wilhelm van Eimeren, the founding father of scientifically independent health system research in Germany. On his initiative, the then Federal Ministry of Research (90% of the funding) and the Free State of Bavaria (10%) created the Institute for Medical Informatics and Systems Research (MEDIS) in 1978. Because of the required multidisciplinarity, it was assigned to a large research facility, the then Society for Radiation and Environmental Research (GSF) in Neuherberg near Munich. Health system research was represented in MEDIS in particular by Detlef Schwefel and his colleagues. The main topics in the 80s were:

  • Development of indicator systems and testing of routine health care data as well as participation in the development of German health reporting
  • Research into the relationships between the economy and health at the micro and macro level and corresponding advice to the Council of Europe and the World Health Organization
  • Evaluation of health policies - e.g. B. cost containment measures - and technology impact assessment, e.g. B. Artificial intelligence in medicine
  • European cost and cost-effectiveness analyzes, e.g. B. with regard to AIDS and chronic psychosis
  • Promotion of health system research in Europe (in cooperation with the Concerted Action Committee for Health Services Research (COMAC) of the European Community)
  • Promotion of health economics and health planning (as a Collaborating Center for Health Planning and Health Economics of the World Health Organization (WHO))
  • Evaluation and planning of health programs in developing countries

The 1980s were marked by an upswing in health system research. Springer Verlag published a series on health systems research and health systems research between 1984 and 1991. Under the name International Society on System Science in Health Care (ISSHC), an international scientific society was established that remained active until 2004. Wilhelm van Eimeren was the driving force behind these initiatives.

The promotion of health research in Germany

At the end of the 1970s, what was then the Federal Ministry for Research and Technology (BMFT) started the first “Federal Government Program for the Promotion of Research and Development in the Service of Health 1978–1981”. In addition to universities, private organizations and consulting firms were also funded. Government funding for health research gave rise to private consulting firms, for example:

  • In 1980 the consulting company for applied systems research (BASYS) was founded by Markus Schneider near the University of Augsburg.
  • In the same year Wilhelm Schräder and other employees at the Technical University of Berlin founded the Institute for Health and Social Research (IGES), which was later headed by Bertram Häussler.

The consolidation of health system research in Germany

Health system research was finally also anchored at the University of Hanover . There Manfred Pflanz rehabilitated the German social medicine after National Socialism and World War I in the Institute for Epidemiology and Social Medicine until his death in 1980. In 1985 Friedrich Wilhelm Schwartz was appointed to his chair and expanded the range of tasks of this institute to include health system research. He represents this discipline to the present day.

The status and perspectives of health system research at the end of the last century were outlined and outlined by Friedrich Wilhelm Schwartz and colleagues in the 1990s. A memorandum was written for the German Research Foundation . She defined health system research on the basis of 10 exemplary topics

  • Health policy (control and implementation research, system comparisons)
  • Health reporting
  • Financial position, funding flows and macroeconomic assessment
  • Requirements and needs research in the health sector
  • Healthcare Management
  • Evaluation research
  • Quality assurance and research
  • Prevention and health promotion
  • rehabilitation
  • Nursing research

At the end of the last century, König and Stillfried also published a method-critical, interdisciplinary and practical status report on health system research. They emphasize the tension between medicine, economics, ethics and health policy.

Health systems research, public health and health services research

Since then, there has been less and less talk of health system research as an independent subject in Germany. Other names for (new) branches of health sciences compete for attention and research funding, especially public health and health services research .

At the beginning of the 1990s, more than a dozen university master’s and later also bachelor’s courses in health science, which were mainly offered under the names of "public health", epidemiology, health and / or nursing sciences, were created in Germany - funded by the federal government become. In particular, the English term public health, which has also become common in German but is misleading, has since superimposed that of health system research, although the two areas of health sciences are not congruent. Sometimes health sciences and public health are equated. The subject of health sciences experienced a strong upswing - also due to the establishment of a social science faculty for health sciences at Bielefeld University - and the aforementioned postgraduate courses. The choice of names for the sub-areas of health research was also determined by the focus of funding by federal ministries. For example, the Federal Ministry for Education and Research (BMBF) funded public health from 1992 to 2003 and health services research from 2000 to 2008. To support the acquisition of third-party funding, the terms of health services research and management in the health care system increasingly shaped the scientific scene.

Since the end of the 1990s, it has become common practice to emphasize and promote individual sub-disciplines instead of the term health system research, initially health economics and environmental epidemiology . The MEDIS institute was broken down accordingly and linked to the university. This corresponded to the facultative structures of universities and the disciplinary requirements of university courses. The integrative, synthetic and systemic idea of ​​inter-, multi- and transdisciplinary health system research was lost.

Publications on health (system) research according to Google Ngram Viewer

After the turn of the century, only a few new university institutions or project areas bear the name of health system research, e.g. B. at the Charité Berlin and at the University of Witten / Herdecke. In these institutes, health services research is primarily conducted and taught as a sub-area of ​​health system research. Other newly established institutions have different names, although they are very active in health system research, e.g. B. the Department of Management in Health Care at the Faculty of Economics and Management at the Technical University of Berlin . Reinhard Busse heads this department and the WHO Collaboration Center for Health System Research and Management and shapes health system research in Germany and Europe.

The graph shows the development of publications on four (overlapping) subject areas between 1960 and 2008 based on the mention of certain terms in Google Books: health research, health system research, health services research and health sciences.

Current status of health system research in Germany

The most frequently cited definition of health system research in Germany is: "Health system research deals with the need, utilization, resources, structures, processes, results and attributable results (" outcomes ") of systemically organized approaches to disease prevention, control or management - i.e. H. of entire health systems, subsystems, institutions and programs - and combines these elements in an analytically evaluating way. Health system research that relates to the micro level - in particular to institutions, programs or individual health technologies - is also referred to as health services research ”. In addition to international health system comparisons, the main topics are:

  • Need, demand and use: Who wants and who should use the health system, and who actually does it?
  • Financial resources, system structure and organization: How much is used for what in the health system?
  • The process of health care: which services are provided where, by whom, how and in what quantities?
  • Results and results: what is the health system doing?
Health systems research levels

This definition relates primarily to three of four levels of health system research, to the micro and meso level - health services research - and to the macro level - i. H. on everything that is consciously done to improve health. The diagram outlines the levels. A fourth level marked the beginning of health system research in Germany and is becoming increasingly important according to current international understanding: the determinants of health and health systems.

The nature of health systems research - systematic social science thinking in contexts and exploring the relationship between health and society - is increasingly penetrating questions and research, for example, to health sociology , health politics , health economics or management call in healthcare. Some scientists and consultants look beyond their faculty boundaries and research the connections between different levels of health system research, even at the risk of being no longer understood by academically specialized experts (peers) because they work across borders. In the development from a medical sociology to a health sociology and the establishment of a health policy, the theoretical deficit of health system research is increasingly addressed, as is the comparison of health systems.

German health system research was unable to independently set itself apart from new trends. Perhaps that is exactly what it is all about - it is not about consolidating a single subject in competition with others. It's about a way of thinking and researching in context and in the interests of society. The WHO's 2012 strategy on health systems research has the appropriate motto: change your mindset and attitudes (changing mindsets).

International health systems research

Since the year 2000, health system research has been receiving increasing attention internationally, after a few English-language publications since the mid-1980s had drawn attention to this research area.

The impulses of the World Health Organization

The work of the World Health Organization (WHO) pointed the way. The WHO World Health Report 2000 compared the performance of health systems around the world. For this purpose she used the following input-output model of the health system, i. H. Health care functions are designed to achieve specific goals.

The health system according to the World Health Report 2000
  • The functions of the health care system are: management (supervision), financing (collection, consolidation, purchasing), resources (investments and training) as inputs for services (offers).
  • The goals are improved health, while the non-medical expectations of the population should also be met and financial fairness applies.

An empirical review of the achievement of goals in 191 countries around the world produced surprising and controversial results. Germany, for example, ranked behind Colombia.

This basic pattern of health system research connects:

  • Inputs or building blocks: health policy, legislation, control, regulation, information, finances, organizations, institutions, professionals, technologies, products, behavior, knowledge
  • Throughputs or processes: reforms, management, services, creation of human and physical resources, organization and control of financing, promotion of leadership, a sense of responsibility, and services in the public interest but also self-help by families and communities
  • Conditions: quality, security, needs-based approach, efficiency, effectiveness, accessibility, range, etc.
  • Outputs, results and goals: health, justice, fairness, humanity, satisfaction, risk protection, freedom of choice, quality of life, well-being, prosperity.

Some of these input-throughput-output system models focus on people, while others focus on responsible, good and ethical leadership (stewardship and governance).

Current status of international health system research

In the first decade of this century, WHO's conception of health systems and health systems research expanded. In 2009 a WHO expert commission asserted that without understanding the health system, the simplest measures to improve the health of the population often fail. This is mostly not due to the measures, but rather to ignorance of the system in which they are supposed to work. Any intervention - from the smallest to the broadest - has an impact on the entire health system, and the entire health system has an impact on every intervention.

For this reason, the WHO is now advocating a further definition of the health system and thus health system research. It no longer relates only to the sphere of activity of the health ministries. It follows on from the Tallinn Charter of 2008, the theme of which was “Health Systems for Health and Wealth” - prosperity, mind you, not just wellbeing; "Health systems encompass both individual and population-based health care, but also measures that are intended to induce other policy areas to address the social, environmental and economic determinants of health in their work". Strengthening health systems is currently one of six priorities of the WHO. "Health systems research is widely recognized as essential to strengthen health systems, provide cost-effective treatment for those who need it, and achieve better health around the world."

Health systems research is no longer just related to the health sector, health care or health system in the narrower sense - it is now defined as "the targeted creation of knowledge which enables societies to organize themselves in such a way that health and health systems are improved". It is quite deliberately also about the determinants of health outside of the health system. An Alliance for Health Policy & Systems Research is working for the WHO to develop the WHO strategy for health systems research, which was launched at the end of 2012. Health systems research and health policy research are linked. In 2016, no German institution was represented among the 320 institutional partners in this alliance. An International Society for Health Systems Research was founded at the end of 2012 under the name Health Systems Global . and since 2015 a new journal called Health Systems & Reform has been published in close association with Harvard University . Its aim is to promote health system research and to translate existing and emerging knowledge so that it can be used by health systems to improve the health of the population. This is seen more and more not only nationally, but also globally, because of the diverse networks of key areas of influence.

Health systems research "is emerging as one of the most dynamic and complex areas in health sciences". In addition to financing, employees and the organization of health care are now particularly important topics

  • Governance , stewardship and knowledge management , for example related to (ethical) leadership, accountability, prioritization, rationing, evidence-informed politics, effective intersectoral approaches
  • Global influences, for example the effects of global initiatives, trade, the world economy, whereby wars, droughts and climate change are not neglected.

In this context there is also the “Health in All Policy” launched by the WHO in the middle of the first decade of the century, which endeavors to recognize “all policies such as transport, environment, education, financial policies, tax policies and economic policies” as determinants of health to influence responsibly. The key word is: intersectoral governance for the emphasis on health in all policies.

Social, economic, cultural, political, technological, legal, environment-related influences on health, well-being and prosperity are again moving more into the focus of health system research, just as they had already influenced the health system research in Germany that was emerging in Germany in the 1970s by the IIASA. At the same time, the too often neglected area of ​​health produced by families and self-help is taken into account again. It is particularly important for prevention and health promotion and thus for the effectiveness and efficiency of the health system.

The scope of health systems research

Areas of health systems research

Health systems research is “thinking in contexts” and requires “systems thinking skills”. These connections can be seen more closely or further. A particularly narrow definition of the health system only takes state or public institutions into account, as the term public health suggests to the uninitiated. Private and family health help is not addressed in it, and neither is the important self-help through health literacy of the individual. The Federal Ministry of Health (BMG) represents such a narrow definition of the health system. The motto is: "The state sets the framework - the partners of the self-government shape the medical care".

A broader health system term includes “all activities whose main aim is to promote, restore and / or maintain health”. For a long time, this was in line with the scientific usages of research since the early 1990s. Intended, unintentional and undesirable effects and side effects of other influencing factors on health and the healthcare system are not addressed.

In a broader sense, it is about the relationships between health, healthcare, society and the environment. This broad definition has been represented by the International Institute for Applied Systems Analysis (IIASA) since the early 1970s. It is currently gaining ground again. In times of globalization, national and international health policies cannot alone determine the framework. It is also about scientifically researching and influencing the unintended and undesirable side effects of globalization, financial crises and economic systems on health and justice. The graphic outlines the relationships in which health system research is currently understood internationally.

Health system research topics in the broader sense

Health services research and public health are components of health system research. The main topics of these two branches of research are presented in detail in other Wikipedia articles. Therefore, only those topics are emphasized in the following that go beyond this.

Health reporting

The first major health system research project in Germany was advice on developing national health reporting . In the 1970s, the meaningfulness of routine data in the German health care system was discussed and researched intensively and controversially between ZI and WIdO. Based on models from other countries - in particular England, Denmark and Sweden - the call for systematically coherent health reporting was loud in the 1980s. This should give an overview of preliminary services, structures, processes, results and framework conditions of the health care system, i. H. over the entire health system in a very broad understanding. In some federal states - z. B. North Rhine-Westphalia - models were tested. On behalf of the Federal Ministry for Research and Technology, a group of 11 research institutes took stock and developed a concept proposal.

Federal health reporting (GBE) has been carried out by the Robert Koch Institute (RKI) and the Federal Statistical Office since the end of the 1990s . Different tasks are performed by both institutions: The RKI designs and develops the reporting system in terms of content and concept, creates and publishes the health reports; the Federal Statistical Office procures the data, processes it and makes it available as an online database in the health reporting information system. The topics of the GBE are:

  • Framework conditions of the health system
  • Health situation
  • Health problems, diseases
  • Health behavior and risks
  • Services and utilization
  • Expenses, costs and financing
  • Health care resources

The federal health reporting at the RKI provides the information in various forms of publication. On the one hand as Reports Health in Germany , first published in 1998, the second in 2006. These give an overview of the health of the population and health care. Other forms of publication include themed booklets, articles and GBE compact, an online information series. The health reports provide reliable information about the entire health system and encourage analyzes and dialogues. In 2015 the latest health report for Germany was published.

National health accounts

National health accounts are a specialty of health reporting. They try to systematically represent and analyze the entire structure and all flows and functions of health expenditure. Here, too, it concerns the entire health system. The focus is on the following questions:

  • Who is paying? - Sources of funding, e.g. B. households, contributors, governments, support groups and others
  • Who is being paid? - Suppliers and intermediaries of goods and services, e.g. B. Doctors, hospitals, pharmacies and others
  • What is paid for? - Health care functions, e.g. B. Prevention, outpatient care, hospital care, rehabilitation, food hygiene, drinking water control, environmental protection, etc. In the "etc." the scope of reporting on the financing is determined. It can be very wide or very narrow. In order to take emerging trends and new markets into account, self-help groups, wellness products, food additives and the like are increasingly included.
  • Who is it good for? - Recipients of the products and services and possible discrimination from the point of view of fairness and justice.

The answers to these four questions are intended to identify how resources are used in the entire health system and how health policies or reforms work. Under the heading of boundaries of health accounts, investments, basic and advanced training of human capital, research and development, environmental hygiene, traffic safety and more are taken into account in order to be able to adequately answer the basic questions. The analysis of this data focuses on questions of needs-based justice, effectiveness, efficiency, equal distribution and other intended and undesired effects and side effects.

The Organization for Economic Cooperation and Development (OECD) and the World Health Organization (WHO) played a leading role in the development of internationally comparable systems of health accounts. In 2004, the European Commission (EC) and the Statistical Office of the European Community (Eurostat) agreed a joint strategy with the OECD and WHO to harmonize standards and definitions and to simplify data collection in order to provide comprehensive reports on European countries and to influence the harmonization of health systems can. National health accounts are now regularly created in almost every country in the world.

Health system comparisons

Health system comparisons have become a focus of health system research. Health system comparisons are used in very different ways.

  • Performance: In 2000, the WHO controversially compared the performance of 191 health systems - measured against eight indicators of health, financial fairness and responsiveness to non-medical expectations of patients - and thus triggered a boom in health system comparisons.
  • Finances: Health expenditure accounts have been standardized very strongly by the OECD, WHO and the EU. Most countries in the world provide comparable data.
  • Statistics: Internationally comparable data on key aspects of health systems - health status, resources, utilization, expenditure, risk factors, demographics, economy, socio-economy - are provided in particular by the OECD and WHO. A list of currently 85 health indicators is intended to support European health reporting.
  • Reports: Using a standardized table of contents, descriptions and analyzes of the health systems in more than 50 countries are made available by the European Observatory on Health Systems and Policies and updated from time to time. The OECD also periodically collects comparative data on the health systems of all OECD countries and publishes periodic reviews of the health systems of individual countries and overviews of all countries. The European regional office of the World Health Organization competes with a European health report. The 2009 report emphasized health and health systems, the 2015 report is based on evidence. In 2003 the European Commission delivered a particularly good report on the social dimensions of health and healthcare in Europe.
  • Topics: Health system comparisons on individual subject areas enrich the scientific and political discussion, for example about
    • Supply models - e.g. B. Bismarck, Beveridge, Siemaszko (Semashko) versus Markt
    • Health insurance
    • Health reforms
    • Coping with economic and political crises
    • Health care service catalogs
    • or other changing topics such as B. Utilization, age structures, quality indicators, quantity control in the pharmaceutical sector
  • Perspectives: For example, a Swedish research group and - on the basis of surveys - the British Commonwealth Fund enable health system comparisons from the patient's perspective.
  • Provocations: With the help of incisive individual fates, Michael Moore shed light on the differences between health systems in the USA, Canada, England, France and Guantanamo (!) From the perspective of those affected in his film Sicko .

System comparisons should protect against research provincialism, unnecessary duplication of research and development in other sectors, hasty generalizations of national peculiarities and also against problem-solving fatalism by subjecting one's own health system to comparisons on at least three levels:

  • As shown above, a national or regional system comparison is mostly used: Presentation and analysis of system (parts) of health care and the causation of diseases in other countries, sometimes also in extreme comparisons with poor developing countries.
  • Comparison over time: Historical analyzes of developments in the health care system and its framework conditions (in other countries) are another good source of knowledge in health system research, which, however, is rarely used. They also enable drafts of interventions or systems of health care in terms of future research. Quasi-time comparisons are also based on extreme regional comparisons.
  • Sector comparison: The analysis of other areas of social production or supply (e.g. infrastructure, energy, social welfare) can provide information on the expected effects and side effects of planned measures or policies. In addition, it is a topic of health system research to analyze the health effects of measures in these areas.

Health system comparisons are a quasi-substitute for experiments in one's own health system. Historical examples, examples in other sectors and examples in other countries and continents already exist for many planned interventions.

Health system management

Due to the complexity of historically grown, very ramified and difficult to understand health systems in highly developed societies, health system management is mainly used in emerging and developing countries. With the Declaration of Alma-Ata (1978) and the draft of a pyramidal supply system, the WHO had given a defining example of pragmatic health system management. Health care modernization programs are supported in various countries by the European Community, the World Bank and the United Nations. In developing countries, health system research is used particularly heavily and increasingly by the World Bank. At present, working groups of the World Health Organization are increasingly promoting the use of health system research to strengthen health systems. The World Economic Forum also makes contributions to this. Health systems research is intended to influence health policies. In addition, health system management also emphasizes policies that affect the health system from beyond.

Policy evaluations

Evaluations are a central topic in health system research. The first step is to determine the benefit or the effectiveness or effectiveness of measures. Effectiveness is usually defined as the achievement of goals, efficiency as the cost of achieving the goal. Evaluations of more complex measures, policies and reforms are the real profession of health system research. In doing so, the diverse objectives of different actors, participants and affected parties and competing measures and interventions in very different environments and contexts must be taken into account. The evaluation of complex health policies, for example for cost containment in the health care system, must go far beyond cost-effectiveness analyzes. The technology assessment of large-scale technologies is an example of complex evaluations in health system research. The analysis of health reforms has become a focus of health system research.

Economy and health

A key theme of research on health systems is the question of the interrelationships between economy, health and health care. Social medicine, a historical forerunner of health system research, has been targeting the social causes of illness and death since Virchow. Since 1955, Thomas McKeown had shown, using many examples, statistically that in England over the past centuries the development of the economy and the environment had a stronger influence on the decline in mortality from serious infectious diseases - e.g. B. tuberculosis, measles, diphtheria - as the development of effective prevention strategies, vaccines or drugs. This hotly debated thesis also shaped health system research emerging in Germany. At the suggestion of the WHO European Regional Office and for the Council of Europe, links between unemployment and health were explored at both societal and individual levels. H. economically, socially and psychologically. The topic is still topical, for Germany, for Europe and also worldwide. Research on the relationship between poverty, income, education, housing, living conditions and health is a topic of social etiology but also of health system research; it is about the determinants of health and healthcare. A milestone was a large-scale study of the WHO on economics and health in 2000 under the direction of the macroeconomist Jeffrey Sachs, in which the mutual relationships were analyzed and conclusions for the world economy and development policy were drawn. The connections between health systems, health, prosperity and social well-being are increasingly being researched more intensively. Fair and universal health insurance for everyone has become an important key issue in international health economics in recent years.

Health and Justice, Wellbeing, Prosperity, etc.

Beyond all pragmatism, health system research tries to become increasingly more fundamental. The Nobel laureate in economics, Amartya Sen , provided a major impetus. International organizations are also involved, e.g. B. with more research on “good governance” in the health system. According to the United Nations Development Program (UNDP), components of this governance are: transparency, participation, consensus orientation, accountability, responsiveness, integration and equal treatment, effectiveness and efficiency, compliance with the law. Series of articles in major journals now cover issues such as justice and governance. Health systems research also focuses on the relationships between health, globalization and justice, and between health and happiness.

Health systems research methods

The subject of health systems research is complex, dynamic and adaptable systems with “myriads of components (such as citizens, patients, communities, providers, politicians, program managers, etc.) that constantly interact and adapt to changes in other components and the environment. The peculiarity of health and other complex systems concern self-organization, constant change, feedback loops, non-linearity, time delays between measures and results, historical references, and unintended consequences of political interventions ”. It is very little about simple relationships between cost and effectiveness, for example. It's not about individual but diverse realities. It's not just about measurable and observable things, but also about subjectively meant meaning and social constructs. It's not just about knowledge, but also about interpretation. It's about a variety of influences. It is about a complicated architecture of social relationships with diverse influences and effects. It is rarely about experiments and hypothesis testing, but mostly about studies in a natural and social environment. It's not just about science, but that knowledge creates something.

Many sciences with different paradigms are involved in health system research, particularly social science disciplines such as sociology, economics, political science, psychology, anthropology, epidemiology, ethnology, geography, management, history, and education. Other disciplines are increasingly joining in. All of these disciplines have in common that they seek, understand and convey empirically and / or theoretically comprehensible evidence.

However, health systems research is not just what the individual disciplines involved are researching. It is characterized by a perspective that adapts problem recognition, guiding principles and methods to the whole of its subject area and not (only) to the individual parts. As a result, it is no more superficial or unscientific than the more traditional academic disciplines such as epidemiology or economics. A look at interrelationships should make health systems understandable and promote scientific and pragmatic innovations. Health systems research is

  • multidisciplinary in the sense that many scientific disciplines are involved with their respective repertoire of methods,
  • interdisciplinary in the sense that different disciplines have to work together in order to understand a topic together
  • transdisciplinary in the sense that new things are created through cooperation between different disciplines and that science and policy advice often enter into a symbiosis.

Health system research is an umbrella term for the disciplines involved and at the same time an independent discipline, depending on the research question and topic.

In the dialogue with medicine, health system research often has to defend that randomizations (strict comparisons between the consequences of the intervention and a non-intervention) and quasi-experimental research approaches can usually not be carried out and that the strict methodological Cochrane criteria for solid scientific studies often are not met. This is based on the inability to generalize the results, the problematic comparability of (political) interventions, the inadequate applicability of other experiences, different priorities and the social and cultural heterogeneity of the environments; In addition, transferability and standardization of the knowledge acquired cannot usually be guaranteed. Classical science proceeds analytically. It divides the object of investigation into smaller and smaller units and hardly emphasizes its environment and its changes. System-oriented research, on the other hand, emphasizes the interaction of different units and must consider behavior, social, institutional and cultural aspects of the health system and its fellow players. This requires exploratory, descriptive and evaluating procedures and a large number of quantitative and qualitative, descriptive, analytical and evaluative methods.

See also

literature

  • Health system analysis project: Health system in the FRG. Materials for analysis . Publishing house for the study of the labor movement, Berlin 1973, ISBN 3-87975-015-7 .
  • Dimitri D. Venediktov: Systems analysis of health services. In: Norman TJ Bailey, Mark Thompson (Eds.): Systems aspects of health planning . Proceedings of the IIASA Conference, Baden, Austria, August 20-22, 1974, North-Holland Publishing Company, Amsterdam 1975, ISBN 0-444-10841-6 , pp. 19-30, iiasa.ac.at (PDF)
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Individual evidence

Most of the links were checked on December 16, 2016 and were valid at that time.

  1. ^ Constitution of the World Health Organization 1946. (PDF) p. 1.
  2. ↑ Health21: the health for all policy framework for the WHO European Region (PDF) World Health Organization (European Health for All Series; No. 6) 1999, ISBN 92-890-1349-4 ISSN  1012-7356 , p. 211.
  3. ^ Ottawa Charter for Health Promotion. (PDF) 1986 pp. 1-2.
  4. ↑ Amartya Sen: Health in Development . ( Memento of the original from March 24, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) In: Bulletin of the World Health Organization. Volume 77, Number 8, 1999, pp. 619-623. @1@ 2Template: Webachiv / IABot / cdrwww.who.int
  5. ↑ SJ Hoffman 2012, p. 18 - see Bibliography Hoffman 2012, p. 18 - see Bibliography A Review of Conceptual Barriers and Opportunities facing Health Systems Research to inform a Strategy from the World Health Organization. (PDF) June 1, 2012
  6. ↑ Venediktov 1975 - see bibliography Venediktov 1975 - see bibliography Norman TJ Bailey, Mark Thompson (eds.): Systems Aspects of Health Planning (PDF) August 1974
  7. ^ Project health system analysis 1973 - see bibliography
  8. ↑ Beske 1978 - see bibliography
  9. ↑ van Eimeren 1978 - see bibliography
  10. ↑ today: Helmholtz Center Munich
  11. ↑ Schwefel 1984, Schwefel 1987 - see bibliography and Schwefel 1984, Schwefel 1987 - see bibliography and socio-economic health system research at the MEDIS -Institute of the GSF (PDF)
  12. ↑ see health system research. In: springer.com. Retrieved January 17, 2015 .
  13. ↑ See DNB 780641396
  14. ^ See MH-Hannover: Institute for Epidemiology, Social Medicine and Health System Research. In: mh-hannover.de. July 5, 2000, accessed January 17, 2015 .
  15. ↑ Schwartz 1995 - see bibliography DNB 942604342
  16. ↑ König 1999 - see bibliography, table of contents DNB 95674642x
  17. ↑ see, for example, health sciences
  18. ^ Statement on health services research . (PDF) German Research Foundation
  19. ↑ See the Charité website and the project area's website
  20. ↑ See Teaching - Health - UW / H - University of Witten / Herdecke. (No longer available online.) In: uni-wh.de. October 17, 2014, archived from the original on January 17, 2015 ; accessed on January 17, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.uni-wh.de
  21. ↑ See WHO Collaborating Center for Health Systems Research and Management. In: apps.who.int. Retrieved January 17, 2015 .
  22. ↑ Reinhard Busse 2012 - see bibliography
  23. ↑ Source: Google Ngram Viewer
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  25. ↑ a b Friedrich Wilhelm Schwartz / Reinhard Busse 2012, p. 555 - see bibliography
  26. ↑ See peer review
  27. ↑ see: Klaus Hurrelmann: Health Sociology. An introduction to social science theories of disease prevention and health promotion. 6th edition. Juventa Verlag, Weinheim / Munich 2006, ISBN 3-7799-1483-2 .
  28. ↑ see: Michael Noweski, Fabian Engelmann: What is health policy? Development status and development potential of the political science contribution to health system research . Berlin 2006 (series of publications by the Public Health research group, research focus on work, social structure and the welfare state, Berlin Science Center for Social Research (WZB) ISSN  1860-8884 )
  29. ↑ Claus Wendt: The health system comparison: Concepts and perspectives . Mannheim Center for European Social Research; Working Papers 88, Mannheim 2005 ISSN  1437-8574
  30. ↑ a b WHO 2012 - see bibliography
  31. ↑ Especially Taylor 1984 - See bibliography
  32. ↑ WHO 2000 - See bibliography
  33. ↑ Savigny 2009 (PDF) see also the WHO glossary and the current philosophy Everybody business: strengthening health systems to improve health outcomes: WHO's framework for action . (PDF) World Health Organization, Geneva 2007, ISBN 978-92-4-159607-7 .
  34. ↑ Gilson 2012 - see bibliography
  35. ↑ Alliance 2004, WHO 2007 - see bibliography
  36. ↑ a b Savigny 2009 - see bibliography
  37. ^ World Health Organization: The Tallinn Charter: Health Systems for Health and Wealth. (PDF) Tallinn 2008, p. 1.
  38. ↑ WHO 2007 - see bibliography
  39. ↑ Hoffman 2012, p. 27 - see bibliography
  40. ↑ Scaling up research and learning for health systems: now is the time . (PDF) Report of a High Level Task Force, presented and endorsed at the Global Ministerial Forum on Research for Health 2008, Bamako, Mali. World Health Organization, Geneva 2009, p. 7.
  41. ↑ David V. McQueen, Matthias Wismar, Vivian Lin, Catherine M. Jones, Maggie Davies (eds.): Intersectoral Governance for Health in All Policies. Structures, actions and experiences . (PDF) WHO, Copenhagen 2012, ISBN 978-92-890-0281-3 .
  42. ↑ Ghaffar 2014 and 2016 - see bibliography
  43. ↑ Hoffman 2012 - see bibliography
  44. ^ Health Systems Global Organization
  45. ↑ Antoun 2015 - see bibliography
  46. ↑ Bennett 2015 - see bibliography
  47. ↑ Hafner 2013, Schäferhoff 2015, Carey 2015 - see bibliography
  48. ^ First global symposium on health systems research . (PDF) World Health Organization, Montreaux 2010, p. 2.
  49. ↑ Timo Ståhl, Matthias Wismar, Eeva Ollila, Eero Lahtinen, Kimmo Leppo (eds.): Health in All Policies. Prospects and potentials (PDF) Helsinki (Ministry of Social Affairs and Health) 2006, ISBN 952-00-1964-2 , pp. Xxvii
  50. ↑ McQueen 2012 - see bibliography
  51. ↑ Reich 2016 - see bibliography, doi: 10.1080 / 23288604.2016.1220775 (PDF)
  52. ↑ Diagram (PDF) Federal Ministry of Health
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  55. ^ Josef Brecht, Martin Pfaff, Elisabeth Schach, Friedrich Wilhelm Schwartz, Thomas Schäfer, Detlef Schwefel (eds.): Structure of a health report. Inventory and concept proposal . Expert opinion on behalf of the Federal Ministry for Research and Technology. Final report. Volume I-III. Asgard Verlag, Sankt Augustin 1990, ISBN 3-537-78701-4 , ISBN 3-537-78702-2 , ISBN 3-537-78703-0 .
  56. ↑ T. Lampert, K. Horch, S. List u. a .: Federal health reporting: goals, tasks and possible uses. Edited by the Robert Koch Institute, Berlin. GBE compact 1/2010.
  57. ^ The federal health reporting information system. Federal Office of Statistics
  58. ^ Robert Koch Institute in cooperation with the Federal Statistical Office: Federal Health Reporting. Health in Germany. Robert Koch Institute, Berlin 2006, p. 220.
  59. ^ Federal health reporting. Health in Germany 2006 . Robert Koch Institute, Berlin 2006.
  60. ↑ RKI - GBE compact. In: rki.de. December 8, 2014, accessed January 17, 2015 .
  61. ^ Robert Koch Institute (Ed.): Health in Germany. Federal health reporting. Berlin: Jointly supported by RKI and Destatis. RKI, Berlin 2015, ISBN 978-3-89606-225-3 rki.de (PDF)
  62. ^ A system of health accounts . (PDF) Organization for Economic Co-operation and Development, Paris 2000.
  63. ^ Health Accounts . Jean-Pierre Poullier, Patricia Hernandez, Kei Kawabata: National Health Accounts: Concepts, Data Sources And Methodology . ( Memento from July 1, 2004 in the Internet Archive ) (PDF)
  64. ^ A System of Health Accounts . OECD Publishing, Paris 2011, ISBN 978-92-64-11601-6 , ec.europa.eu (PDF) Health expenditure according to the European Commission (website of the European Commission) ( Memento of the original dated December 28, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. ec.europa.eu (PDF) @1@ 2Template: Webachiv / IABot / ec.europa.eu
  65. ↑ Bui 2015 - see bibliography doi: 10.2471 / BLT.14.145235 (PDF)
  66. ↑ Claus Wendt: The health system comparison: Concepts and perspectives . (PDF) Mannheim (University of Mannheim, Mannheim Center for European Social Research) 2005. Claus Wendt: Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare . (PDF) In: Journal of European Social Policy. 2009 19 (5), pp. 432-445 .; Marcial Velasco Garrido, Reinhard Busse : Health Systems Research in Europe . (PDF) In: Johan Hansen (Ed.): Health Services Research into European Policy and Practice . Final report of the HSREPP project. NIVEL, Utrecht 2011, ISBN 978-94-6122-086-8 and Martin Schölkopf: The health system in international comparison. Comparison of health systems and European health policy . Medical Scientific Publishing Company, Berlin 2010, ISBN 978-3-939069-74-4 .
  67. ↑ WHO 2000 - see bibliography - for criticism see Stefan Greß, Stephanie Maas, Jürgen Wasem: Effectiveness, efficiency and quality reserves in the German health system . Hans Böckler Foundation, Düsseldorf 2008, WHO 2000 - see bibliography - for criticism see Stefan Greß, Stephanie Maas, Jürgen Wasem: Effectiveness, efficiency and quality reserves in the German health system . (PDF) Hans Böckler Foundation, Düsseldorf 2008.
  68. ↑ see above all: Health Accounts. In: who.int. Retrieved January 17, 2015 .
  69. ↑ See international data. Retrieved January 17, 2015 .
  70. ↑ see also Markus Schneider: Health system research and health statistics in the European Union. Status and perspectives with regard to the “open method of coordination”. In: GGW (Journal of the Scientific Institute of the AOK ), Vol. 2, Issue 2, 2002, pp. 15–21. See: gbe-bund.de See also echim.org
  71. ↑ z. B. about Slovakia, see Smatana 2016 in the bibliography
  72. ↑ OECD: Health systems characteristics survey 2016 - see bibliography
  73. ↑ z. B. about Latvia 2016 - see bibliography OECD 2016
  74. ↑ z. B. OECD: Health at a Glance 2016 in the bibliography
  75. ↑ The European Health Report 2009. Health and Health Systems. World Health Organization, Copenhagen 2010, ISBN 978-92-890-3415-9 .
  76. ^ The European Health Report 2015. Looking beyond the goals - new dimensions of the evidence . World Health Organization, Copenhagen 2015, ISBN 978-92-890-3430-2 , euro.who.int (PDF)
  77. ↑ European Commission: The Social Dimension of Health . In: European Commission: The social situation in the European Union 2003 . Brussels (EK) 2003 ISSN  1681-164X , pp. 27-106, ec.europa.eu (PDF) and (website)
  78. ↑ see: Johan Hansen (Ed.): Health Services Research into European Policy and Practice . (PDF) Final report of the HSREPP project. Utrecht: NIVEL, 2011, ISBN 978-94-6122-086-8 .
  79. ^ Richard B. Saltman, Reinhard Busse , Josep Figueras (eds.): Social health insurance systems in western Europe . (PDF) Maidenhead (Open University Press) 2004, ISBN 0-335-21363-4 .
  80. ↑ Jeremy Hurst: Effective Ways to Realize Policy Reforms in Health Systems. Paris (OECD Publishing: OECD Health Working Papers, No. 51) 2010, doi: 10.1787 / 5kmh377l4n9x-en see also Bertelsmann Health Policy Monitor for 20 countries
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  82. ↑ Fritz Beske, Thomas Drabinski, Ute Golbach: Service Catalog of the Health Care System in International Comparison - An Analysis of 14 Countries. - Volume I. Structure, Financing and Health Services. (Fritz Beske Institute for Health System Research) Kiel 2005.
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  84. ^ Arne Björnberg: Health Consumer Powerhouse. Euro health consumer index 2012 . ( Memento of the original from May 25, 2017 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) Danderyd Sweden (Health Consumer Powerhouse) 2012, ISBN 978-91-977879-9-4 . @1@ 2Template: Webachiv / IABot / www.healthpowerhouse.com
  85. ↑ Cathy Schoen, Robin Osborne: The Commonwealth Fund: 2010 international health policy survey in eleven countries . ( Memento of the original from February 5, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) PowerPoint presentation. @1@ 2Template: Webachiv / IABot / www.commonwealthfund.org
  86. ↑ Primary Health Care . (PDF) Report of the International Conference on Primary Health Care. Alma-Ata, USSR, September 6-12, 1978. World Health Organization, Geneva 1978.
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  91. ↑ World Economic Forum 2015 - see bibliography under Boston 2015
  92. ↑ Koon 2013 - see bibliography
  93. ↑ David V. McQueen, Matthias Wismar, Vivian Lin, Catherine M. Jones, Maggie Davies (eds.): Intersectoral Governance for Health in All Policies. Structures, actions and experiences . (PDF) WHO, Malta 2012, ISBN 978-92-890-0281-3 .
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  95. ↑ see also Yip 2015 - see bibliography
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  98. ↑ Thomas McKeown: The Role of Medicine: Dream, Mirage, Or Nemesis? Oxford (Blackwell) 1979, ISBN 0-691-02362-X .
  99. ↑ see e.g. B. Emily Grundy: Commentary: The McKeown debate: time for burial. In: Int. J. Epidemiol. , June 2005, 34 (3), pp. 529-533, doi: 10.1093 / ije / dyh272 .
  100. ↑ Detlef Schwefel, Per-Gunnar Svensson, Herbert Zöllner (Eds.): Unemployment, social vulnerability, and health in Europe . (Springer-Verlag: Series: Health Systems Research) Berlin 1987, ISBN 3-540-17867-8 , 325 pages.
  101. ^ Council of Europe: Effects of long-term unemployment on health . Strasbourg (Council of Europe) 1987, ISBN 92-871-0997-4 .
  102. ↑ Thomas G. Grobe, Friedrich W. Schwartz: Unemployment and health . (PDF) Berlin: Robert Koch Institute 2003, ISBN 3-89606-140-2 , ISSN  1437-5478 .
  103. ↑ M. Harvey Brenner: Health and quality in work. Impact of Macroeconomic Factors on Mortality in Europe and the OECD - Final Report -. Brussels (European Commission, Directorate General for Employment, Social Affairs and Equal Opportunities, Unit D1) 2006 VC / 2004/0256.
  104. ↑ Thomas Kieselbach, Anthony H. Winefield, Carolyn Boyd, Sarah Anderson (Eds.): Unemployment and health. International and interdisciplinary perspectives . Bowen Hills (Australian Academic Press) 2006, ISBN 1-875378-61-8 .
  105. ↑ Jeffrey D. Sachs et al. a .: Macroeconomics and health: investing in health for economic development . (PDF) Report of the commission on macroeconomics and health. Geneva (WHO) 2001, ISBN 92-4-154550-X and Jeffrey D. Sachs: Economics and Health: Investing in Health as a Contribution to Economic Development . (PDF) Society for Technical Cooperation, Eschborn 2001.
  106. ^ Josep Figueras, Martin McKee (Ed.): Health Systems, Health, Wealth and Societal Well-being. Assessing the case for investing in health systems . (PDF) Open University Press, Maidenhead 2012, ISBN 978-0-335-24430-0 .
  107. ↑ z. B. Greer 2015, Grupta 2015, Cotlear 2015, Kutzin 2016 - see bibliography
  108. ↑ Summers on behalf of 267 economists 2015 - see bibliography
  109. ↑ Amartya Sen: Health in Development . ( Memento of the original from March 24, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) In: Bulletin of the World Health Organization. 1999, 77 (8), pp. 619-623; see also competence approach . @1@ 2Template: Webachiv / IABot / cdrwww.who.int
  110. ↑ Ilona Kickbusch , David Gleicher: Governance for health in the 21st century . (PDF) World Health Organization, Copenhagen 2012, ISBN 978-92-890-0274-5 .
  111. ↑ on this topic is e.g. B. a whole series of articles in the journal Health Care Analysis - Journal of Health Philosophy and Policy 2015 - see z. B. Coggon in the bibliography
  112. ↑ A series of articles in the journal Social Science & Medicine deals with these topics using the example of Asia, see e.g. B. Phua 2015 in the bibliography
  113. ↑ Oliver Razum, Hajo Zeeb, Ulrich Laaser (eds.): Globalization - Justice - Health. Introduction to International Public Health . Hans Huber, Bern 2006, ISBN 3-456-94354-7 . Zeeb works at the Leibniz Institute for Prevention Research and Epidemiology
  114. ↑ Sithey 2015 using the example of Bhutan - see bibliography
  115. ↑ Swanson 2012, p. Iv55, see also: Savigny 2009 - both in the bibliography
  116. ↑ see also: L. Gilson, K. Hanson, K. Sheikh, IA Agyepong, F. Ssengooba, S. Bennett: Building the field of health policy and systems research: social science matters. In: PLoS medicine. Volume 8, number 8, August 2011, ISSN  1549-1676 , p. E1001079, doi: 10.1371 / journal.pmed.1001079 . PMID 21886488 . PMC 3160340 (free full text).
  117. ↑ see e.g. B. Lucas 2016 in the bibliography
  118. ↑ Varkevisser 2003 - see bibliography
  119. ↑ Taylor 1984, Grodos 2000, Gilson 2012 - see bibliography
  120. ↑ Hoffman 2012 - see bibliography
  121. ↑ Grodos 2000 - see bibliography
  122. ↑ z. B. Ozawa 2013 - see bibliography