'All the stars were aligned'? The origins of England's National Institute for Health Research
'All the stars were aligned'? The origins of England's National Institute for Health Research
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DOI：
10.1186/s12961-019-0491-5
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发表时间：
2019-12-04
影响因子：
4
通讯作者：
Walley, Tom
中科院分区：
文献类型：
--
作者：
Atkinson, Paul;Sheard, Sally;Walley, Tom
背景：2006年，英国国家医疗保健体系——国家医疗服务体系的研究与开发活动进行了改革。在卫生部内建立了一个国家卫生研究所（NIHR），这是第一个将这一活动作为一个综合系统管理的机构，从而大大增加了政府资金。本文调查了国家卫生研究院是如何成立的，以及它为什么采取这种形式。我们的目标是更好地理解“我们是如何走到这一步的”。方法：对38名关键证人进行口述历史访谈，召开证人研讨会，并查阅已发表和未发表的文献资料。结果：实证医学对服务政策的影响越来越大，新公共管理思维方式的增长，有利于卫生研发投资的经济政策以及卫生保健公共资金的增加，是影响国家卫生健康政策起源的最重要因素。我们注意到卫生研究系统和卫生保健系统之间强有力的双向互动——虽然有利于研究的使用，但卫生保健方面的挑战（例如走走停停的资助）也可能给卫生研究带来挑战。结论：了解英国如何以及为什么会有一个集中的卫生服务研究系统，以及一个长期建立的生物医学研究资助者（医学研究委员会），有助于我们解释英国卫生研究经验对其他国家的意义，并有助于英国决策者更好地了解他们目前的选择。要从英国卫生研究体系的特点中吸取教训，就需要了解形成这一体系的过程。首先，公共资助、国家组织的医疗保健特点促进了政府对循证医学的兴趣，简化了研究的优先次序，并有助于促进研究结果的实施。其次，一个重视研究对健康影响的团体的领导作用至关重要，确保利用新的管理方法（如指标和竞争性招标）来造福患者，而不是将其本身作为目的。政府愿意为更广泛的经济目标投资研发的政策窗口，以及对卫生系统的充足资金，也得到了有效利用。
Background: In 2006, the research and development (R&D) activity of England's national healthcare system, the National Health Service, was reformed. A National Institute for Health Research (NIHR) was established within the Department of Health, the first body to manage this activity as an integrated system, unlocking significant increases in government funding. This article investigates how the NIHR came to be set up, and why it took the form it did. Our goal was a better understanding of 'how we got here'.Methods: We conducted oral history interviews with 38 key witnesses, held a witness seminar, and examined published and unpublished documents.Results: We conclude that the most important forces shaping the origin of NIHR were the growing impact of evidence-based medicine on service policies, the growth of New Public Management ways of thinking, economic policies favouring investment in health R&D and buoyant public funding for healthcare. We note the strong twoway interaction between the health research system and the healthcare system - while beneficial for the use of research, challenges for healthcare (such as stop-go funding) could also produce challenges for health research.Conclusions: Understanding how and why England came to have a centralised health service research system alongside a long-established funder of biomedical research (the Medical Research Council) helps us interpret the significance of the English health research experience for other countries and helps English policy-makers better understand their present options.Learning lessons from the features of the English health research system calls for an understanding of the processes which shaped it. Firstly, the publicly funded, nationally organised character of healthcare promoted government interest in evidence-based medicine, made research prioritisation simpler and helped promote the implementation of findings. Secondly, the essential role of leadership by a group who valued research for its health impact ensured that new management methods (such as metrics and competitive tendering) were harnessed to patient benefit, rather than as an end in themselves. A policy window of government willingness to invest in R&D for wider economic goals and buoyant funding of the health system were also effectively exploited.