Ron Andersen Interview

     Ron Andersen:    Very important.     A-N-D-E-R-S-E-N.   Well,

that's easy to do.

     Jennifer Muldoon:     So are we ready?

     Male Voice:     You're ready and rolling.

     Jennifer Muldoon:     Okay.   So Doctor Andersen, why did you

first choose to work in the field of health services research?

     Ron Andersen:     I chose health services research because as

I graduated from college, I was looking to go to a doctoral

program in sociology and I applied to a number of schools,

including Purdue University that had a training program in

something called medical sociology.       And it was not only of

interest to me, a health field generally, but they offered the

best fellowship that I was offered.       So I went there in medical

sociology and learned about doing health surveys and other

aspects that are associated with health services research, and

that led me into the field.

     Male Voice:     Can you try to get a touch more background?

     Jennifer Muldoon:     In your opinion, what are some of the

most significant challenges for health services research?          I'm

sorry, I said the question wrong.       What are some of the most

significant contributions of health services research?

     Ron Andersen:     To me, the most significant contributions

have to do with conceptualization of what a health services
system is.   I learned a lot from my second mentor after the

training program and Robert Eichorn from Oden Anderson at the

University of Chicago.   And I think that's had a lot to do with

the contributions that the field has made.   And related is the

idea that to understand health services use and the outcomes, we

really have to spend a considerable amount of time thinking

about and measuring and associating with outcomes the multiple

determinates of service use.   And we need a concept of a health

services system to do that.

     Jennifer Muldoon:   What are some of the biggest

opportunities for the field?

     Ron Andersen:   The biggest opportunities at this point, I

think, have to do with what I consider to be effective and

efficient measures of health services use and particularly

access to care.   We've gone past a point of being primarily

concerned about getting care, although that's still extremely

important, but now the issues are how much does that care

contribute to the health of the population and the people

receiving it, and how can we do it most efficiently, that is, to

get the best care in terms of outcome at the least expenditure

resources?

     Jennifer Muldoon:   Thinking back to when the Association

for Health Services Research was first formed, why did you

become involved in helping to form this new organization?
     Ron Andersen:     You're not going to ask about advice?

     Jennifer Muldoon:     Oh, I'm sorry, I'm sorry.   [Laughter]   Go

ahead, go ahead.     What advice would you give someone thinking of

getting a career in health services research?

     Ron Andersen:     Talking to young people about beginning a

career in health services research, I would suggest that it's

very important for them to study the basic methods related to

health services research and of a disciplinary perspective,

which gives them some grounding for answering as well as asking

important questions in the field.     A second would be an interest

and an understanding of the concept of the health services

system and what that means and an ability and some experience in

applying the discipline to the actual practical problems in the

health services sector.    And, finally, health services is an

interdisciplinary field - to learn and to work with people from

other basic backgrounds and disciplines to solve the important

questions that were asked in health services research.

     Jennifer Muldoon:     Great.   And, now, why did you become

involved in helping to form a new organization - the Association

for Health Services Research?

     Ron Andersen:     I was asked to join the board, and I had

some questions about whether we needed another organization.        It

seemed to me that I was involved with many organizations and

many meetings related to my field, and I wasn't sure that
another organization would be the best use of my time or the

best use of the field.   However, Bill Pierskalla called me and

he said, "You and the University of Chicago need to be

represented on this board."   So, actually, that was why I went,

initially.

     And I can't say that this was a decision - and I changed my

mind about, but fundamentally, I'm quite conservative.    I don't

mean about particular values, but I mean about change.    A new

organization is a commitment of resources and it took me a while

to come around, but fortunately, maybe there's another question

where you ask about the contributions of the field.    I'm glad I

did, given what's happened with the organization since.

     Jennifer Muldoon:   And what were the founders' goals for

AHSR when it was first created?

     Ron Andersen:   The founders' goal, as I remember it, was to

bring together multiple perspectives in the field.    I answered

an earlier question - I was involved with people with these

multiple perspectives, but we or they were in different

organizations at different times.   What this organization did

was to bring together these multiple perspectives in one setting

to talk and interact, which made a lot of sense given that we've

just discussed that this is an interdisciplinary field.

     And to advance - a second objective - to advance the field

that we were establishing and legitimizing, to improve the
methods and approaches and theoretical perspectives that might

help us with perspectives.   And a third, which I barely

understood but learned more about, in part because of the field,

was to try to support an effective lobby for the interest of

what was then the National Center for Health Services Research

and a general understanding and support of the government and

other possible funders for the importance of the work and the

provision of resources for it.

     Jennifer Muldoon:    How has your involvement with AHSR

influenced your career?

     Ron Andersen:   I think it's influenced my career by helping

me to see the importance of something I believed in but didn't

always know how to contribute to and that was to work from

multiple perspectives and with people from these different

perspectives in a very supportive and collaborative way.    And,

generally, it provided a professional and social quorum for

health services researchers, which I've valued a lot over the

years.

     Jennifer Muldoon:    Now thinking to the original purpose of

the annual meeting - what was the original purpose of the AHSR

annual meeting?

     Ron Andersen:   I think to legitimize, in part, this

professional organization.    Professional organizations meet

annually and come together to share their work and interests,
and so we did the same with this meeting.     I don't know.   I

can't quite - basically, the idea, another idea for a

professional organization is to legitimize to the outside world

that this is really a meaningful organization that comes

together, has the resources, will have the continuity, continue

to build on its work and to interact with the significant

stakeholders that might be interested in what that organization

is doing.

     Jennifer Muldoon:   What were the pressing health services

research topics, issues, at the early meetings?

     Ron Andersen:    Some of the important health services

research issues at the early meeting fortunately, or

unfortunately, are the same as they are today.     We talked a lot

because we're concerned with rising costs of medical care, the

outcomes of health services use.    I was interested in access,

and then people began to say, "Access for what?"     So we tried to

think about linking this to outcomes and the modeling, the

formal modeling, of health services use, which has been a

continuing interest of mine for a long time, and fortunately

shared in the Association at that time.

     Jennifer Muldoon:   What do you think attracted people to

that first meeting?

     Ron Andersen:    A lot of the people at the first meeting

were colleagues of people on the board.     Just like Bill
Pierskalla called and asked me to be on the board.   We certainly

went to our colleagues and our students and said this is an

important thing for you to do.    And I think what was also

appealing was that many of us were marginal in the sense that we

worked in organizations where health services research was not

foremost and you had to legitimize the work you were doing, and

here was a place you could go and work and begin to establish

ties without having to define and defend whether health services

research was an appropriate endeavor.

     Jennifer Muldoon:   What are some of your favorite memories

of the annual research meeting?

     Ron Andersen:   Okay, my favorite memories.   I think a

continuing role of the agency was to link the related work and

people of the past with the present and the future, and we were

very fortunate to have a traditional cadre of contributors who

were recognized at the very first meeting, and I'll always

remember.

     Jennifer Muldoon:   Where do you see

     Ron Andersen:   I'm not finished.

     Jennifer Muldoon:   Okay, go ahead, sorry.

     Ron Andersen:   They're all gone, you know.   Sam Shapiro was

in the first group and strong on epi [sounds like] and

disciplinary approaches and methodology and design, and Abbidas

Donabeatti [phonetic] I know was the guru of quality and
continues to be so.     And the third person, actually he's listed

as the second year as an investigator, but I remember

introducing him at the very first meeting along with the other

two - Oden Anderson - the person who, I believe, formulated and

first coined the concept of heath service system and linked that

to national health surveys and the need for data to explain the

system and, certainly, was foremost in developing international

comparisons.   He devoted his life to studying particular

countries - England and Sweden and the U.S. - and so he was

recognized for those.    And all that happened at the first

meeting, and that would certainly be my fondest memory of the

meeting.

     Jennifer Muldoon:    Where do you see the annual research

meeting twenty-five years from now?

     Ron Andersen:    I wondered if you meant was it going to be

in Peoria, Illinois [laughter].     I think we'll still be engaged

it - oh - what we'll be working on twenty-five years from now, I

think we'll still be concerned with what I've described as

efficient and effective access to health services.    And the

biggest challenges to us will still be measuring outcomes,

understanding what the importance outcomes are, especially for

the elder who are consuming more and more of the resources and

we have to understand what's a reasonable approach to providing

care, the resources necessary for the quality of life and the
appropriate outcomes for them and not breaking the bank to do

so.

      What can the Academy do to make this happen?   Continue to

make the case for the importance of objective health services

research, strengthen the relationships with our interacting

stakeholders, providers, the government, the insurance industry

or what will be the insurance industry then, and helping us to

understand of how we go about the business of asking, as well as

answering the most important questions in health services

research.

      Jennifer Muldoon:     Anything else?

      Ron Andersen:   No.    [Laughter]