Developing Relevant Health Policy

The following is from a presentation by Tim Size, RWHC Executive Director at the first annual conference of the Wisconsin Network for Health Policy Research (11/97); the session was entitled "Ensuring the Usefulness of Health Services Research for Policy-Making: Perspectives from the Field:"

It is an honor to have been asked to speak during part of the time originally allocated to Alice Hersh, until her untimely death, Executive Director of the Association for Health Services Research. She made a real difference in organizing the research community to better inform the development of health policy; her ongoing contribution will be missed. I will also remember her as a particularly stylish person, the one person I knew who regularly wore my favorite perfume, Rive Gauche.

My wish list for health services research:

#1 Integrate Public/Private Distinctions

Yesterday David Kindig mentioned that he and I have been having an ongoing discussion regarding the development of public policy and whether there is a comparable body of processes that constitute the development of private policy. I am embarrassed to say I forgot to tell him that I just ran into what may be an answer.

I was in the lost luggage line at the Madison airport and overheard E.G. Dionne from the Washington Post being introduced right behind me. I couldn’t pass up the opportunity this gave me to confirm the meaning of a quote of his that I had recently read "politics is the art of how we organize ourselves." This is a nice conceptual bridge of the similar activities many of us have long experienced in both public and private arenas. I think he agreed with the expanded use of his quote but then I was between him and his lost luggage.

To take this idea one step further, if politics is the art of how we organize ourselves, then health policy is a product of that art. All health related organizations are simultaneously operating in both public and private arenas and effected by the policies, "rules" or traditions of public and private politics alike.

Given our huge public investment in the private health care sector and the increasing use of market forces to allocate those resources, we need health service researchers to think outside the box of traditional public policy. We need to better understand how the de facto policy development within the private sector affects the development of traditional public policy and vice versa, and how research can inform the whole interactive mess.

#2 Address Policies That Are Not Spoken.

Health policy exists whether or not we choose to recognize it, whether or not we have spoken it, whether or not it is the result of a deliberative process.

I hesitate to offer this audience the following example but I will—some public medical schools have seen themselves as responsible for how well their graduates practice medicine but have been indifferent to where they practice. Silence on this issue constitutes a very definite policy that at worst reinforces physician maldistribution, at best make no contribution to its remedy.

Another example: in the private sector, there is a widely unexamined belief that all you have to do to have competition in health care is to minimize government regulation. While recognizing the hostility that has greeted discussion in this area, the health services research community must more aggressively speak to the relative silence supporting the notion that "free" markets are inherently competitive.

#3 Accept the Challenge to Be Relevant

As David previously noted, health services research has a role as change agent that includes first documentation, then analysis and finally prescription. The bad news is that in this context, quite a lot is expected from health services researchers; the good news is that many are meeting the challenge with:

Courage—the courage to be data driven, particularly when we "so called users" may make that position un-comfortable.

Integrity—the integrity to be self aware of and try to keep your work clean of your own personal, professional and institutional biases; we all have them and researches are not exempt.

Vision—the vision to be working on the prescriptions for tomorrow’s problems while we still have the time to do the research, agree on policy and make a difference.
Engagement—include providers and policy-makers in partnership; just as health is too important to be left solely to professional care givers, so is research too important to be left solely to professional researchers.

#4 Remember Health Care’s Inherent Intimacy

I need to remind myself and each of you—we see what we look for. Our work is consumed with tactics and strategies driven by dollars, market share and the competitive value of quality score cards; health services research faces the same problem.

But we are much more than "covered lives" or focus group fodder; we are individuals, workers and on a good day, voters. My weekends like yours are sometimes not related to work. Last weekend I visited two friends in Chicago who were the new, proud grandparents of twins born prematurely, now at home doing well after a long hospitalization. At the same time, an old friend spent the weekend with his family, dying at St. Mary’s here in Madison.

We need to remember that for health services research to have real meaning it must seek the larger, more holistic perspective that integrates the science of public and private sector policy development with the reality of our most intimate life events.