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Lecture 12

HLTC15 Lecture 12

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Health Studies
Suzanne Sicchia

HLTC15 –Introduction to Quantitative and Qualitative Health Research Methodologies Lecture 12: Comparative Health Research (Chapter 20) Tuesday, November 27, 2012 Introduction  Approaches  Politics  Methodological Challenges Approaches to Comparative HR 1. Substantive Focus: 2. Level of Analysis o Macro: often test a hypothesis o Meso: focus on organization of health services o Micro: concerned with specific aspects of H/C behaviour and practice 3. Study Purpose o Exploration: same phenomenon, different settings o Explanatory: set out to determine why differences exist o Evaluation: assess impacts of services and policies in different countries against specific criteria of success/failure Examples of Comparative Health Research Advantages of Comparative H/R  Potential to learn from mistakes of others  A kind of ‘natural experiment’  Seen as more ‘credible’ because they’re informed by more than personal judgement of policy makers Comparative HR is deeply Political  Highly politicized process, particularly when trying to evaluate what works best  Process of policy learning itself is selective, often reflects the specific, domestic agendas (of policy makers)  Best practices are deeply embedded in highly specific national, social, economic, historical, and political contexts and therefore cannot be transferred easily Specific Methodological Challenges  Sampling  Comparability  Complexity  Ideal Types  Limitations of Typologies Methodological Challenges: Sampling  Rational for comparison: studying differences or similarities?  Case Selection depends on study’s theoretical framework: Most Different or Most Similar designs o –EXAMPLE 1: if cross-country learning is more likely where there are similarities in mode of H/C delivery -- Most Similar Design o –EXAMPLE 2: Why have markets in H/C have been implemented in very different ways – Most Different Design  Requires well defined, a priori framework and study rational Methodological Challenges: Comparability  A strategy whereby theoretically insignificant background variables are held constant  Must determine and declare comparable units in advance: o –Example: Choosing countries with comparable levels of economic wealth, with stable democratic political systems, and with developed welfare states  Must understand differences in language, cultural meanings, related function – formal and functional equivalence o –Example: same word used (hospital) , but different cultural meanings and functions Methodological Challenges: Complexity  Difficult to manage quantity, diversity, and complexity of data collected in a systematic and meaningful way throughout the research process  What data is relevant and in what way  A priori theoretical framework help researchers to make these determinations Methodological Challenges: Ideal Types  Especially common in meso-level comparative HR  During data processing and interpretation a clustering of explanatory factors – grouped into “ideal types”  Useful for establishing typologies that explain variations of health policies across different countries o –Choosing an ‘ideal’ from a typology of models of health systems organization (ie, national health service model, social insurance model, private insurance model) EXAMPLE: These Authors Conclude that Welfare States with Strong Social Protections (Scandinavian) are an Ideal Case in Terms of Self-Rated Health Limitations of Typologies  Overly simplistic abstractions – context matters!  Comparisons focus on differences from the ideal type; fail to effectively compare across different countries o Example: comparisons of h/c workers that rely on Anglo-American profe
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