Improving Health Services
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Improving Health Services

Background, Method and Applications

Walter Holland

This insightful book describes how Health Services Research (HSR) can be developed and used to evaluate, advance and improve all aspects of health services. It demonstrates the need for good HSR to avoid the continuation or development of ineffective or cost-inefficient services.
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Chapter 2: Health services research in the United States

Background, Method and Applications

Walter Holland


The focus on HSR in the US – which developed earlier there than in the UK and before the Second World War – was largely with the distribution and utilisation of health services within the insurance system since there is no national health service. HSR was initially concentrated on the development of the basic disciplines, particularly sociology, the organisation of medical services and organisational structures, as well as the financing mechanisms for research. HSR was also undertaken immediately after the Second World War in a limited number of organisations, such as the Veteran’s Administration, the New York Department of Health and the Kaiser Permanente Health Foundation. The emphases for this research were on equity of access, moderation of costs and assurance of quality. HSR emerged as a distinctive activity in 1969 as part of the programme of the National Center for Health Services Research and Development. The programme was focused on improvement in the organisation, delivery and financing of health care through the introduction and testing in real community situations of carefully designed innovations in specific aspects of health care delivery. Among these areas of research which will be considered here were health manpower, health care facilities, organisation and administration of health services, evaluation, methods of financing health care, social behavioural aspects of health care, nursing, dental health, and health care technology. This chapter ends with a comparison of HSR in the US and the UK.

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