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Introduction to Health Services Research : A Self-Study Course
Module 2: Brief History of Health Services Research (Page 18 of 40)
Changes in Leadership in Health Services Research
National Health Insurance
Between 1948 and 1951, national health insurance was officially part of the Truman platform. However, the national health insurance legislation was defeated as a result of the Congressional elections in 1950 and the Eisenhower landslide two years later.
Leadership in Health Services Research
At this point the leadership in health services research also began to change. Most of the research on health services in the 1950s was sponsored by health planning agencies, hospital associations, the pharmaceutical industry, large prepaid group practices, and city and state health departments.
Department of Health, Education, and Welfare (DHEW)
The Department of Health, Education, and Welfare (DHEW) established in 1953 by President Eisenhower. DHEW was later to become Department of Health and Human Services on May 4, 1980. DHEW's responsibilities as they do now, included the funding and oversight of research.
NIH Nursing Research Study Section
The NIH Nursing Research study section was established in 1955 within the Division of Research Grants to conduct scientific review of the growing volume of applications in this area.
Health Services Publications
Two years later, Jeremy Morris published an important epidemiology book titled, Uses of Epidemiology which was a cornerstone book that formed the basis of future work in chronic disease epidemiology (Morris, 1975). JS Mausner and S Kramer wrote Epidemiology, an introductory text in 1985 for those entering the field (Mausner, 1985).
Institute of Medicine (IOM)
Important for its publications in a variety of health services and policy research areas, the Institute of Medicine was established in 1970 to examine issues that affect the health of the public. Most of the work (and resulting publications) is done by committees made up of members nominated to the Institute. Resulting studies and other activities are requested and funded by the federal government. (More information on IOM in Module 3).
Social Aspects: Quality and Equality
In the social arena, the civil rights and anti-poverty movements of the late 1950s and 1960s generated action and passion for quality and equality in all aspects of life, including health and economic security, among millions of people. This activism influenced the passage of several pieces of important social legislation, including the Medicare and Medicaid Acts in 1965 that extended health care coverage to people who were older, disabled, or poor.
Public Health Training
The Comprehensive Health Planning and Services Act of 1966 subsidized training in public health and was intended to fund the establishment of public health services, and assist states in coordinating health programs to move toward comprehensive statewide coverage.
Neighborhood Health Centers
The Office of Economic Opportunity (OEO) supported neighborhood health centers beginning in 1966 under the direction of Julius B. Richmond, M.D. Neighborhood health centers were transferred to PHS jurisdiction in the early 1970s and were renamed community health centers.
Fee for Service Reimbursement
Again, the government had the resources to accept responsibility for the health needs of vulnerable populations. Providers were reimbursed for services rendered in a fee for service arrangement.
View Key Projects and Milestones in Health Services Research.
Discussion Questions
- Most of the research on health services in the 1950s was sponsored by health planning agencies, hospital associations, the pharmaceutical industry, large prepaid group practices, and city and state health departments. Why would these organizations be so interested in health services research issues?
- Several key pieces of legislation were enacted as a result of the civil rights and anti-poverty movements of the late 1950s and 1960s. Why did these movements encourage enactment of Medicare and Medicaid?
- Discuss the role of the Institute of Medicine in health policy and health services research.
- Why were the neighborhood health centers so important? Can you find articles dealing with the role they played in the provision of health care to the underserved? What health services research came out of this movement?
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