gms | German Medical Science

Background: European health systems face large and common challenges as a result of demographic, epidemiological and ecological changes. Policy-makers look for solutions in other regions or countries, but lack the knowledge and capacity to evaluate solutions in terms of transferability to their setting. Biomedical research programs can only reap their benefits if they lead to application within health care. However, the health system conditions for successful application are usually not systematically addressed. Against this background the Horizon2020 Coordination and Support Action TO-REACH was initiated.

Objective: The aim of TO-REACH is to develop a research agenda that can be used by ministries of health, national research funding organisations and the European Commission to stimulate and fund international comparative research around health policy and service innovations. This research agenda will be based on a combination of two strands. The first is an analysis of knowledge gaps in the area of transferability and up-scaling of health policy and service innovations, the absorptive capacity in health systems that want to take over innovations and the consequences for health system performance. The second strand is an inventory of policy priorities that stakeholders in countries and at European level see as key policy and service areas for innovation and cross-border learning.

Methods: The analysis of knowledge gaps has been done through desk research in the form of a conceptual review of the literature and case studies. The inventory of policy priorities has been done by analysing existing national and international policy documents and roadmaps, by meetings with stakeholder in a number of countries and by an online consultation. These are the inputs for drafting a strategic research agenda to be used by representatives of ministries of health and research funders, including in the German context.

Results: Knowledge gaps relate among others to what aspects of context are important in the international transfer of health policy and service innovations. An important question is whether relevant aspects of context depend on the specific problem and organizational solution or can be generalized over different situations of transfer. Absorptive capacity in the receiving health system is an important condition for successful implementation of an innovation. It is unclear how absorptive capacity works in cross-border learning and how it should be measured in empirical research. Finally, an open question is which countries are in a favourable position to learn from each other; the problem of the comparator countries.

The inventory of policy priorities tends towards the following: Overarching priority is the move from disease-oriented to patient-centred care and from there to person- and population-centred care. Successful change requires integration of care across all healthcare sectors and across traditional boundaries, including those with social care, occupational health and prevention outside the healthcare system. To give leverage to this change a number of policy areas are instrumental. Long-term care has to be developed to meet future demands; hospitals will have to take up new roles and organisational structures; integrated services require strong primary care and adequate human resources; finally, care of the future requires adequate information and communication technology embedded in a people-centred approach of health care provision. The inventory is still in progress and especially the country level nuances are still lacking. Presentation of these outcomes will also allow for validation of priorities from a German perspective.

Discussion: Comparative health systems and services research is an underfunded area of research in a time where research is expected to lead to patents and economic spin-offs. Nevertheless, big changes such as integration of care, people- and person-centred care and self-management can benefit from health systems and services research. Too often, foreign solutions are championed without adequate evidence and insight in transferability. It is important that countries put together funds to make research in this area possible. Europe is our comparative research laboratory.

Practical Implications: The development of a strategic research agenda for international comparative health systems and services research may create new opportunities for evidence-based policy learning and for research cooperation between health systems and services researchers in different countries.