How Can Payback from Health Services Research Be Assessed?

Abstract

Throughout the world there is a growing recognition that health care should be research-led. This strengthens the requirement for expenditure on health services research to be justified by demonstrating the benefits it produces. However, payback from health research and development is a complex concept and little used term. Five main categories of payback can be identified: knowledge; research benefits; political and administrative benefits; health sector benefits; and broader economic benefits. Various models of research utilization together with previous assessments of payback from research helped in the development of a new conceptual model of how and where payback may occur. The model combines an input-output perspective with an examination of the permeable interfaces between research and its environment. The model characterizes research projects in terms of Inputs, Processes, and Primary Outputs. The last consist of knowledge and research benefits. There are two interfaces between the project and its environment. The first (Project Specification, Selection and Commissioning) is the link with Research Needs Assessment. The second (Dissemination) should lead to Secondary Outputs (which are policy or administrative decisions), and usually Applications (which take the form of behavioural changes), from which Impacts or Final Outcomes result. It is at this final stage that health and wider economic benefits can be measured. A series of case studies were used to assess the feasibility both of applying the model and the payback categorization. The paper draws various conclusions from the case studies and identifies a range of issues for further work.

Políticas y gestión de la investigación

“…Buxton 3 define el rendimiento de la investigación biomédica, haciendo hincapié en el carácter multidimensional de sus resultados. Ello lleva a señalar la diversidad de las valoraciones e intereses correspondientes a los diferentes actores participantes en lo que podemos conceptuar como proceso de la actividad investigadora, y que pasa por las etapas de: priorización, evaluación, selección, financiación, ejecución, difusión y aplicación de la investigación.…”

“…Esta diversidad de valoraciones y preferencias supone, en un entorno participativo con asignación colectiva de recursos, una clara y transparente asignación de prioridades de investigación, y la elección de las alternativas organizativas y los objetivos socialmente más eficientes 4 . Tenidas en cuenta las circunstancias que determinan el rendimiento, resulta posible el diseño de una cadena de valor de la investigación, que permita identificar las etapas de la misma de manera esquemática y los actores que intervienen 3,4 . (Tabla 1) La primera etapa, supone el análisis de la situación a través de la identificación y estimación de necesidades de investigación, y el establecimiento de prioridades, con arreglo a criterios explícitos.…”

“…En este caso, la necesidad definida por expertos (p.e. la comunidad de investigadores) suele prevalecer sobre la preferencia individual como criterio de asignación de recursos 3,4 . Una vez identificadas las necesidades es preciso identificar criterios de priorización para compararlas.…”

The 'Payback Framework' explained

“…Group (HERG) at Brunel University, UK, to examine the 'impact' or 'payback' of health services research (Buxton and Hanney, 1994;1996). It was further developed in studies of research funded by the National Health Service (NHS) (Buxton and Hanney, 1998), and subsequently extended in collaboration with RAND Europe to also examine basic and early clinical biomedical research Wooding et al, 2005).…”

Channeling health economics research initiatives to improve decision-making processes in the EU

“…The interest in assessing the value of research activities in support of health systems policies was highlighted by Buxton and Hanney 2 decades ago [1]. The need to cope with the gap between research and health policy has also been previously acknowledged by some authors and institutions such as the WHO [2][3][4].…”