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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 12 of 40)

Committee on the Costs of Medical Care

During the 1920s and 1930s, the Committee on the Costs of Medical Care, a leading health services research group of its day, published 27 research reports on health services costs and distribution.

Convened by a small group of physicians concerned about the cost of medical care, it received support from seven major philanthropic organizations (the Carnegie Foundation, Josiah Macy Jr. Foundation, Milbank Memorial Fund, New York Foundation, Rockefeller Foundation, Julius Rosenwald Fund, Russell Sage Foundation, and the Twentieth Century Fund) to study the economics of disease prevention and medical care.

Edgar Sydenstricker (the Hagerstown epidemiology study) was a contributor to the CCMS, as was Isadore Falk, who later became the director of research and statistics in Franklin Roosevelt's Social Security Administration.

Committee Studies Health of the Nation

The Committee published one of the first studies to examine the health of the nation, investigating the use of medical services according to disease, the available medical personnel and facilities, and the cost of existing services (Anderson, 1991). In 1929, it reported that national health expenditures had reached $3.66 billion or $30 per person (small numbers by today's figures!).

The Committee documented an unequal distribution of costs and health care services and recommended increases in medical services rather than improvements in public health, housing, diet, hygiene, and occupational safety. It opposed compulsory health insurance, but the majority supported voluntary medical and hospital insurance.

AMA Opposes Committee Report

The American Medical Association vehemently opposed the report because of its endorsement of voluntary health insurance.

Committee Sets Political Agenda for 25 Years

The Committee's work instigated public interest and established the political agenda for the next 25 years (Starr, 1982).

Committee's Contribution to Health Services Methodology

The Committee also contributed to health services methodology. It conducted chart review studies and emphasized the need for reliable, valid data.

Critical Incident Technique

It applied the critical incident technique to evaluate physician performance, a technique later used by the National Board of Medical Examiners (Flook, 1973).

View Key Projects and Milestones in Health Services Research.

Discussion Questions

  1. The Committee on the Costs of Medical Care reports were published so many years ago. Which types of health services researchers would likely need to see a copy of these reports and where would you get a copy of these reports?
  2. Have the problems identified by the Committee been eliminated? Why or why not?
  3. The critical incident technique was used to evaluate physician performance. Why was it necessary to evaluate physician performance in the '20s and '30s? Is it necessary for us to evaluate physician performance today?
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