Health services research in Europe and its use for informing policy

Abstract

Objective: As an applied field of research, health services research (HSR) is undertaken primarily to inform health care policy. However, the relationship between policy and HSR is not straightforward. Many policies are developed without taking account of available evidence. Our objective was to provide an overview of the infrastructure and capacity of HSR in Europe, and to explore the links between HSR and policy in European countries. Methods: A survey of health policy experts in 34 European countries undertaken between September 2009 and June 2010, covering: funding and prioritizing HSR; production and producers of HSR; health policy users of HSR; activities to promote the use of HSR; and barriers and facilitators to using HSR in policy-making. Experts were selected based on their professional expertise and reputation in HSR and/or health policy. Results: Information was returned from 30 of the 34 countries. Infrastructure and capacity for HSR varied widely across countries as did the mechanisms likely to promote the use of research for national policy-making. In many cases, HSR was not separately identified from other health-related research. Government funding for HSR varied between zero and over €170 million per year (in 2004). Few countries had mechanisms to match HSR priorities with those of policy-makers. Although most countries provided some relevant training, multidisciplinary training was available in few countries. Few mechanisms supporting the use of research in policy were reported. One exception was coverage decisions for new drugs and technologies where formal accountability for the use of health technology assessments appeared to be most developed. Overall, respondents struggled to locate information on many aspects of HSR, particularly its use in decision-making. Conclusion: HSR is unevenly developed across Europe. There is considerable scope to build the infrastructure and to take steps to improve the use of HSR in policy-making. There is also a need for research, as opposed to expert opinion, on how HSR is undertaken and used.