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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 subsample 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.