title: [Health services research: subject matter and objectives of a field at the intersection of economics, medicine and ethics].
abstract: In analogy to the famous saying that war is too serious to leave it to the generals, one could say that the provision of medical care is too serious and too costly to leave it to doctors. This, however.would give the impression of an incongruity which does not exist as an actual factor or as a standpoint in research on the healthcare system. Having said that, there are differences in the methods of observation used: doctors always base their observations on their experiences at the doctor/patient level. In these situations, they are influenced by the therapeutic imperative of wanting to help and their convictions do not allow them to take into account competing requirements or to feel dependent on the higher-level conditions; and the realm of research on the health care system bases its observations more or less on findings derived by means of analysing what is often highly aggregated data, be it of a medical, economic or epidemiological nature. Even though the insights gained at the macrolevel ultimately have to be applied at the microlevel of the doctor/patient relationship, there remains an internal distance from the problems of care which is conducive to proper judgement. From this distant vantage point, researchers attempt to prove the relationship between effort and yield, to indicate weak spots which individual doctors cannot recognise and to define capacity, structure and incentive conditions which guarantee maxi-mum medical care quality. There is, for instance, evidence of astonishing dependence between the medical care provided and incentives for the number of doctor/patient contacts, use of medicines, surgery rates and number of diagnoses. This evidence can be used to draw up recommendations for self-governing bodies in the health care sector and for the political sphere as to how the health care system could be enhanced to achieve a high level of efficiency and quality.
authors.affiliation: WPI e. V. AG Gesundheitssystemforschung, Tübingen.
authors.forename: M
authors.initials: M
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003953:Diagnosis-Related Groups / Q000191:economics; D005260:Female; D005858:Germany; D015276:Health Care Rationing / Q000191:economics; D005102:Health Expenditures; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008017:Life Expectancy; D008297:Male; D006278:Medicare / Q000458:organization & administration; D008875:Middle Aged; D010817:Physician-Patient Relations; D011057:Politics; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014481:United States