Interest in research on health care has become quite substantial, in part as a result of the recent emergence of public-policy concern for quality assurance and cost-containment. Yet, the essence of this novel line of research has remained, regrettably, a matter of confusion. In particular, the distinction between health care research on one side and health research on the other is being missed in some eminent writings. We emphasize that, properly, the former is to be viewed as having health care, rather than health, as its object, and as being largely descriptive fact-finding about the nature and occurrence of various processes of health care. In these terms it serves policy and administrative decisions in the context of whatever knowledge is available from health research--as to the health consequences of such processes of care. Health research (applied), in turn, addresses the nature and occurrence of phenomena of health (their frequency)--in relation to type of health care, inter alia. Using the example of the North Karelia project, we illustrate the negative consequences of including under health care research inquiries into the premises of health care--notably studies on the effects of care on health outcome.
University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for answering such questions as: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served? or do they have poor health outcomes despite being well served? Does high utilization represent overuse? or is it related to high need? More specifically, this system provides decision makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and countries, utilization review within a single hospital, and longitudinal research on health reform. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.
University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design a population-based health information system (POPULIS). Decision-makers can use this system to make critical comparisons across regions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. Policy makers have found this information system useful in providing answers to questions they are often asked: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or is it related to high need? Three commentaries follow.