Health services research

Health services research (HSR) became a burgeoning field in North America in the 1960s, when scientific information and policy deliberation began to coalesce.[1] Also known as health systems research or health policy and systems research (HPSR), is a multidisciplinary scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care.[2] Health Services Research utilizes all qualitative and quantitative methods across the board to ask questions of the healthcare system. It focuses on performance, quality, effectiveness and efficiency of health care services as they relate to health problems of individuals and populations, as well as health care systems. Health Services Research addresses wide-ranging topics of structure, processes, and organization of health care services; their use and people's access to services; efficiency and effectiveness of health care services; the quality of healthcare services and its relationship to health status, and; the uses of medical knowledge.

Studies in HSR investigate how social factors, health policy, financing systems, organizational structures and processes, medical technology, and personal behaviors affect access to health care, the quality and cost of health care, and quantity and quality of life. Compared with medical research, HSR is a relatively young science that developed through the bringing together of social science perspectives with the contributions of individuals and institutions engaged in delivering health services.[3]


The primary goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety.[4] HSR is more concerned with delivery and high quality access to care, in contrast to medical research, which focuses on the development and evaluation of clinical treatments.

Health services researchers come from a variety of specializations, including geography, nursing, economics, political science, epidemiology, public health, medicine, biostatistics, operations, management, engineering, pharmacy, psychology, usability and user experience design.[5] While health services research is grounded in theory, its underlying aim is to perform research that can be applied by physicians, nurses, health managers and administrators, and other people who make decisions or deliver care in the health care system. For example, the application of epidemiological methods to the study of health services by managers is a type of health services research that can be described as Managerial epidemiology.


Approaches to HSR include:[3]

  • Implementation research: research focusing on public policy analysis, or the concerns of program managers regarding the effectiveness of specific health interventions;
  • Impact evaluation: research with emphasis on effectiveness of health care practices and organisation of care, using a more narrow range of study methods such as systematic reviews of health system interventions.

Data Sources

Many data and information sources are used to conduct health services research, such as population and health surveys, clinical administrative records, health care program and financial administrative records, vital statistics records (births and deaths), and other special studies.


Several government, academic and non-government agencies conduct or sponsor health services research, notably the Canadian Institute for Health Information and the Canadian Institutes of Health Research (i.e. the third pillar: "research respecting health systems and services"). Others include the Institute for Clinical Evaluative Sciences (ICES) in Toronto, and the Canadian Collaborative Study of Hip Fractures.

There are some universities which train in health services research. Atlantic Regional Training Centre


Data availability

Several registries are available for research use, such as Danish Twin Register or Danish Cancer Register.[6]


Public Health Research Laboratory.

  • HeSPeR (Health Services and Performance Research), UniversitĂ© Claude Bernard Lyon 1

United Kingdom of Great Britain and Northern Ireland (UK)

Several governmental agencies exist that sponsor or support HSR, with their remits set by central and devolved governments. These include the National Institute for Health Research (NIHR) and its constituent infrastructure (including the CLAHRC programme)[7]; Healthcare Improvement Scotland[8]; Health and Care Research Wales[9]; and Health and Social Care Research and Development[10] Many universities have HSR units, a web search can find these with relative ease.

United States

Data availability

Claims data on US Medicare and Medicaid beneficiaries are available for analysis. Data is divided into public data available to any entity and research data available only to qualified researchers. The US's Centers for Medicare and Medicaid Services (CMS) delegates some data export functions to a Research Data Assistance Center.[11]

23 Claims data from various states that are not limited to any particular insurer are also available for analysis via AHRQ's HCUP project.[12]


Colloquially, health services research departments are often referred to as "shops"; in contrast to basic science research "labs". Broadly, these shops are hosted by three general types of institutions—government, academic, or non-governmental think tanks or professional societies.

Government Sponsored

University Sponsored

  • Center for Surgery and Public Health, U.S. -based research institute at the Brigham and Women's Hospital (Harvard University Affiliate)
  • Regenstrief Institute
  • Institute for Healthcare Policy and Innovation, U.S. -based research institute at the University of Michigan (Founded in 2011, IHPI includes smaller centers focused on specific healthcare topics)
  • Leonard Davis Institute of Health Economics, U.S.-based center for HSR at the University of Pennsylvania

Think Tank or Professional Society Sponsored

See also


  1. Mykhalovskiy, 1999 Knowing Health Care / Governing Health Care : Exploring Health Services Research as Social Practice..
  2. AcademyHealth. What is HSR? Archived 2009-09-01 at the Wayback Machine, June 2000.
  3. Sheikh K, et al. Building the Field of Health Policy and Systems Research: Framing the Questions. PLoS Med, 8(8): e1001073. Published August 16, 2011. Accessed August 22, 2011.
  4. Agency for Healthcare Research and Quality, February 2002.
  5. UX Magazine 14.3 - Healthy Designs, September 2014.
  6. Frank, L. (2000). "Epidemiology. When an entire country is a cohort". Science. 287 (5462): 2398–2399. doi:10.1126/science.287.5462.2398. PMID 10766613.
  7. "NIHR National Institute for Health Research".
  8. "Healthcare Improvement Scotland".
  9. "Health and Care Research Wales".
  10. "HSC Research and Development HSC Public Health Agency".
  11. "ResDAC". Retrieved 30 April 2013.
  12. "". Retrieved 30 April 2013.

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