Policy makers are the doctors of health systems. They are the ones who, when faced with difficult diagnoses – such as inequalities in service access, human resource shortages, poor health outcomes, emerging diseases – select the interventions they believe will restore the patient’s (system’s) health, and oversee adherence to treatment (implementation). They are the individuals and collectives with the power to influence health on a population level. And the power to limit the opportunities of entire countries with poor decisions and inadequate service planning.
Unfortunately for policy makers, however, they are not in the privileged position of today’s doctors, with a vast array of well-researched treatments for the myriad common diseases that burden their patients. The policy makers’ toolkit is limited to the blunt instruments of budgeting, national goal setting, and guideline development. Diagnoses are equally unsubtle: high burdens of disease, low life expectancy, and catastrophic health expenditure, to name just a few.
Systems’ “medicine” is languishing in a time akin to the era when doctors could do nothing for their patients but barbaric surgeries, blood-letting, and doling out reassuring words. If health systems are going to deliver on the population health benefits that should result from medical innovations and advances, this has to change.
Health systems research has much potential to be the science that policy makers depend on to inform their professional decision-making, just as medical science is to doctors. Unfortunately, however, the field does not currently fill this need. But maybe it should.