Gray Bradford H, Gusmano Michael K, Collins Sara R
Division of Health and Science Policy, New York Academy of Medicine, USA.
Health Aff (Millwood). 2003 Jan-Jun;Suppl Web Exclusives:W3-283-307. doi: 10.1377/hlthaff.w3.283.
The Agency for Health Care Policy and Research has had a turbulent history. Created with little opposition in 1989, it narrowly escaped being eliminated in 1995, only to be reauthorized (with a new mandate and name--the Agency for Healthcare Research and Quality, or AHRQ) with overwhelming support in 1999. In focusing on budgetary history, this paper sheds light on why health services research (HSR) has difficulty obtaining funding from a government that is willing to spend vast sums on basic biomedical research. The paper argues that three strategies--bureaucratic, marketing, and constituency building--that advocates adopted in the late 1980s made HSR more visible and consequential and were responsible for AHCPR's budgetary successes as well as its near-demise.
医疗保健政策与研究机构有着一段动荡的历史。它于1989年成立时几乎没有遇到反对意见，却在1995年险些被裁撤，直到1999年才在压倒性的支持下获得重新授权（拥有新的使命和名称——医疗保健研究与质量机构，即AHRQ）。通过关注预算历史，本文揭示了卫生服务研究（HSR）为何难以从一个愿意在基础生物医学研究上投入巨额资金的政府那里获得资金。本文认为，倡导者们在20世纪80年代末采用的三种策略——官僚策略、营销策略和建立选民群体策略——使卫生服务研究更受关注且更具影响力，并且是医疗保健政策与研究机构预算成功以及几近消亡的原因。
