Wednesday, January 23, 2008

Research methods for health care system evaluation

Methods for health care system evaluation are gaining prominence in the scientific discourse of a number of related disciplines including medicine, public health, and medical informatics. A new website by Academy Health ( for health services researchers is available at The website mission states: provides current information on key research methods and resources in HSR, and aims to spur dialogue about analytic methods among health services researchers.

This important collection of resources effectively frames the debate on appropriate choice of methods and statistics for evaluation research in this interdisciplinary field. The resources offered cover research ethics, privacy issues and data sources as well texts and other readings on quantitative and qualitative research methodologies.

Published evaluation research tends to favor quantitative methods. For example, articles appearing in the journal Health Affairs on comparative country analyses often present tabulations of public health data such as per capita spending and population statistics to construct country rankings. While highly instructive, these analyses shed little light on social or organizational logics explaining country level health care system performance. See for example:

Ellen Nolte and C. Martin McKee
Measuring The Health Of Nations: Updating An Earlier Analysis
Health Affairs, January/February 2008; 27(1): 58-71.

Gerard F. Anderson, Bianca K. Frogner, and Uwe E. Reinhardt
Health Spending In OECD Countries In 2004: An Update
Health Affairs, September/October 2007; 26(5): 1481-1489.

William D. Savedoff
What Should A Country Spend On Health Care?
Health Affairs, July/August 2007; 26(4): 962-970.

Qualitative methods offer more opportunities to assess how health care processes work as well as how medical and public health interventions perform. See for example:

Harald Walach, Torkel Falkenberg, Vinjar Fønnebø, George Lewith, and Wayne B Jonas
Circular instead of Hierarchical: Methodological Principles for the Evaluation of Complex Interventions
BMC Medical Research Methodology. 2006; 6: 29.
Available at

Maria Grypdonck,Qualitative Health Research in the Era of Evidence-Based Practice, Qualitative Health Research, 16 (10) 2006, 1371-1385.

See also a report from the Cosmos Corporation by Robert Yin and Darnella Davis: ADDING NEW DIMENSIONS TO CASE STUDY EVALUATIONS: THE CASE OF EVALUATING COMPREHENSIVE REFORMS (2006) available at

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