Rigorous health-systems research?

On November 6, 2008, in health systems, political economy, research, by Karen Grepin

Last week’s Lancet had an editorial from Anne Mills and co-authors that discusses the inherent difficulties in conducting health systems research. They argue that while the standards for such types of studies will never reach the standards required in medical research, they must be improved over the current state of affairs.

As I health systems researcher myself, I could not agree more. I get frustrated at the lack of efforts to properly evaluate health system interventions. I spent last week attending health systems research sessions at the annual APHA conference, and I am not sure I attended a single lecture that even bothered to include a control group. Just because a non-control group study design is a “study design”, it does not make it a good one. A while it is fine to go ahead with such evaluations, because I also agree we can learn from these exercises, caveats must be made, major ones, in the interpretation of the results.

The Mills editorial points out that a major policy initiative, that of user-fees, had limited evaluation prior to its widespread introduction. Had the results of two widely-cited early studies been more carefully examined, or the generalizability of these studies been questioned, we may have come up with a different conclusion about the expected effects of user-fees.

Political scientists, in particular political economists, I feel do a much better job of learning about system level changes. I think health system researchers could learn a lot from learning more about the methods that are employed in these types of studies.

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