Original research Mapping research on health systems in Europe: a bibliometric assessment Marcial Velasco Garrido 1 , Johan Hansen 2 , Reinhard Busse 1,3 1 Department of Health Care Management, Technische Universita ¨t, Berlin, Germany; 2 NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands; 3 European Observatory on Health Systems and Policies, Brussels, Belgium Objective: Europe’s health care decision-makers are facing an increasingly complex and rapidly changing landscape. It is crucial that health care problems are addressed with evidence-informed policy and that evidence finding is aimed at those topics most urgent on policy agendas. Research on health systems addresses the macro-level of health care delivery and aims at generating evidence for policy-making. Our aim was to assess the field of health systems research in Europe, primarily based on an analysis of the published literature. Methods: Starting from current definitions of health systems, during 2004–09 we identified four thematic areas for research and defined keywords to construct a sensitive literature search limited to European research. Results: The database search resulted in 26,945 hits between 2004–09. Until 2008, the annual number of publications on health systems research increased at an average rate of 5.2%. Most (88%) were in English. The largest producer of research on health systems has been the UK (nearly 10,000 in six years; 37% of the total for Europe), which is also the country most frequently the object of research. In contrast, seven countries had produced no publications. There were modest correlations between a country’s research production and its gross domestic product (r 5 0.62) but less so with its population size (0.33). The most frequent keywords were ‘patients’ (49% of all references), ‘patient satisfaction’ (27%), ‘organization and administration’ (23%), ‘education’ (19%) and ‘attitude of health personnel’ (13%). Closer inspection of a sub- sample of 1000 abstracts revealed that only 24% met our definition of ‘health systems research’ rather than other fields of health services research. Conclusion: There is a wide-spread need to develop health systems research capacity, in particular in eastern European countries, and to address the effects of health care reform, particularly the effects of privatization and commercialization of health services. Journal of Health Services Research & Policy Vol 16 Suppl 2, 2011: 27–37 # The Royal Society of Medicine Press Ltd 2011 Introduction Europe’s health care decision makers are facing an increasingly complex and rapidly changing landscape. One of the most prominent developments is the ageing of the population because the demand for care, in par- ticular long term care and palliative care, will probably grow substantially. Non-communicable diseases and in particular chronic illnesses have become the main burdens of disease. 1 It also implies greater emphasis on the need to strengthen preventive care in order to relieve some of the pressure on health systems by ensur- ing larger numbers of people remain active and in good health. The same demographic developments will imply a considerable shift in the workforce. From 2020 onward, there will be fewer people in the working population – if immigration does not increase – able to ensure future prosperity. 2 A second challenge on countries’ health care systems is the high spending on health care, which generally is rising faster than economic growth. 3 In many countries a debate is ongoing as to how to realize major cuts in health care expenditure, even though health spending Marcial Velasco Garrido MPH, Researcher, Department of Health Care Management, Faculty of Economics and Management, Technische Universita ¨t Berlin, Secr H80, Strasse des 17 Juni 135, 10623 Berlin, Germany; Johan Hansen PhD, Senior Researcher, NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands; Reinhard Busse FFPH, Professor and Department Head of Health Care Management at the Technische Universita ¨t in Berlin, Germany and Associate Head of Research Policy and Head of the Berlin hub of the European Observatory on Health Systems and Policies, Brussels, Belgium Correspondence to: marcial.velasco@tu-berlin.de DOI: 10.1258/jhsrp.2011.011041 J Health Serv Res Policy Vol 16 Suppl 2 July 2011 27