In an era of accountability, no-one disputes anymore whether health care evaluation is a legitimate exercise. The hard questions are who is going to get it done and, above all, who is going to pay for it. Those questions were probably at the forefront of people's minds when attending a two-day workshop held in February 1985 in Canberra, Australia. The meeting was organized by the Australian National Health and Medical Research Council (NHMRC), which had brought together some 60 multidisciplinary professionals to review the situation in Australia-epidemiologists, economists, psychologists, medical and management scientists, and sociologists, inter alios. Some thirteen formal papers had been distributed beforehand; and issues raised by these texts were discussed in both plenary and syndicate sessions.
NHMRC has distributed funds on behalf of the Australian Federal Government since 1936. It both commissions specific research projects and grants fellowships to those it considers to be promising research professionals. Its record of achievement is indisputable, while its orientation has been heavily biomedical to the comparative detriment of social and economic research-and researchers. A break-down of all funding avenues for health and medical research in South Australia, for 1985, illustrates this point quite nicely: basic science, 55 per cent; clinical medicine and science, 30 per cent; preventive medicine and science, 5 per cent; health services research, 7 per cent. The major funding source was the NHMRC itself, and the categories nominated are the customary NHMRC ones (Hicks, 1985). Consequently, considerable energy was directed at the workshop towards supporting a resource shift that would bring more funding towards the social and economic end of the health and medical research spectrum.
It remains axiomatic, nonetheless, that shifting resources within a health (or education) system is almost an herculean exercise. In this case, however, momentum had already been provided by a Federal Budget allocation for 1984-85 to establish an Australian Institute of Health (AIH). This Bureau, within the Public Service, will report through the Director-General of Health; but, it has a mandate to initiate its own research programmes and publish its own results . Specifically, it will concern itself with research into the health status of the Australian population, and the provision and utilization of health services. It will have three divisions-Health Economics, Health Statistics, and Health Services-ostensibly designed to promote economic and social investigation of aspects of health system management.