Structure and Dynamics of Health Research and Public Funding An Inte
By gathering institutional details on funding and health research systems in a comparative perspective, Structure and Dynamics of Health Research and Public Funding offers, for the first time, a comprehensive and systematic view of the options and restric
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DIETMAR BRAUN Institute of Political Science, University of Heidelberg, Germany
STRUCTURE AND DYNAMICS OF HEALTH RESEARCH AND PUBLIC FUNDING An International Institutional Comparison
kJ
m KLUWER ACADEMIC PUBLISHERS DORDRECHT / BOSTON / LONDON
A C.I.P. Catalogue record for this book is available from the Library of Congress
ISBN 0-7923-2777-2
Published by Kluwer Academic Publishers, P.O. Box 17, 3300 AA Dordrecht, The Netherlands. Kluwer Academic Publishers incorporates the publishing programmes of D. Reidel, Martinus Nijhoff, Dr W. Junk and MTP Press. Sold and distributed in the U.S.A. and Canada by Kluwer Academic Publishers, 101 Philip Drive, Norwell, MA 02061, U.S.A. In all other countries, sold and distributed by Kluwer Academic Publishers Group, P.O. Box 322, 3300 AH Dordrecht, The Netherlands.
This book was translated by Neil Solomon This work was promoted by the German Federal Ministry for Research and Technology, reference 01 ZZ 8801/3
Printed on acid-free paper
All Rights Reserved © 1994 Kluwer Academic Publishers No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. Printed in the Netherlands
CONTENTS
1. INTRODUCTION
1 PARTI
2. DIMENSIONS OF HEALTH RESEARCH
11
2.1
BIOMEDICAL RESEARCH
11
2.2.
PUBLIC HEALTH RESEARCH
15
3. DYNAMICS OF HEALTH RESEARCH
19
PART 2 4. BASIC PROBLEMS BESETTING CLINICAL RESEARCH
4.1
27
DIFFERENTIATION TENDENCIES EMERGING FROM THE SOCIAL ORGANIZATION OF SCIENCE AND MEDICINE . . .
29
4.1.1 Divergent Cognitive Perceptions as a Dissociating Element
30
4.1.2 Credibility Cycles as a Dissociating Element
32
4.1.3 Institutional Incentives as a Dissociating Mechanism . . .
33
4.1.4 Increasing Complexity as a Dissociating Element
34
4.2
AN INTERNATIONAL COMPARISON OF THE INSTITUTIONAL CONDITIONS OF CLINICAL RESEARCH
36
VI
4.2.1 Explaining Variations in the Role of Clinical Research (I): Differences in the Models of Association Linking Hospitals and Medical Schools
36
4.2.2 Explaining Variations in the Role of (Clinical) Research (II): The Full-Time System 46 4.2.3 Explaining Variations in the Role of (Clinical) Research (III): Differences in the Decision-Making Structures of Medical Departments and Hospitals
52
4.3
58
CONCLUSION
PART 3 5. AN INTERNATIONAL COMPARISON OF HEALTH FUNDING SYSTEMS 65 5.1
GENERAL CHARACTERISTICS OF FUNDING SYSTEMS IN HEALTH RESEARCH
67
5.2
THE SCOPE OF INFLUENCE OF FUNDING
81
5.3
PRELIMINARY CONCLUSIONS REGARDING THE SCOPE OF INFLUENCE OF FUNDING AGENCIES
88
THE ROLE OF POLITICS AND SCIENCE IN FUNDING POLICY AND FUNDING PROCEDURES
90
5.4.1 Forms of Coordination Between Funding Organizations and Political Creditors
92
5.4.2 The Role of Science Within Funding Organizations . .
104
5.4
5.5
CONCLUSION CONCERNING THE INFLUENCE OF POLITICAL AND SCIENTINC INTERESTS ON STRATEGIES O
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