I think before everyone gets excited about the effectiveness research that was funded in the Recovery and Reinvestment Act--basically, using the scientific method to find out how well different medical treatments work--we need to realize that the medical industry might have scored a coup here (italics mine):
The $1.1 billion earmarked for comparative effectiveness research remained in the bill that President Obama will sign Monday. The House conferees also insisted on keeping the phrase "comparative effectiveness" throughout the authorizing language, removing the Senate's insertion of the word "clinical." However, the report language did note its removal was "without prejudice."Now the bad news. From the conference report:
The conferees do not intend for the comparative effectiveness research funding included in the conference agreement to be used to mandate coverage, reimbursement, or other policies for any public or private payer. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition.
The crucial question is whether the Agency for Healthcare Quality and Research (AHRQ) and the Center for Medicare and Medicaid Services (CMS), which get two-thirds of the money with the National Institutes of Health getting the remainder, will be able to take costs into account in determining "effectiveness."
So we can look at clinical outcomes, but not costs? If we can't even consider costs, I don't see how we reduce healthcare expenditures. Yes, for some medical conditions, cost shouldn't really be an issue, but, for others, such as choosing a hypertension drug, costs have to be considered. I guess this is a good start, but, if we want to stop spending around 16% of annual GDP on healthcare, we need to look at costs (of course, letting Medicare and Medicaid bargain with drug companies would help too...)
- Log in to post comments
I have long felt that we need a national medical treatment information system, not just to insure that people with special needs are correctly identified at hospitals other than their "home" hospitals, but also to provide us with a huge database for this kind of analysis. It really would not cost much of our overall spending on health care, and it would provide us with good information on cost-effectiveness of various treatments. That in turn would provide us with a more rational basis for handling health care insurance cases. The big problem, of course, is protecting patient privacy; given the abuses of the previous Administration in areas that we thought were safe, we would need some truly ironclad legal phrasings with specified punishments for violations.
I think that this is a good start. Frankly, most insurance companies already have tiered benefits for prescription medication. It would be nice to have effectiveness influence those tiers, rather than just cost. I would think that the results from the effectiveness studies can help people make better decisions. For example, if I know from effectivenss research that procedure B is no better than procedure A even though A is half the cost, I will tend to think twice about pressing for procedure B. However, the results from the effectiveness studies are going to depend upon effective communication and education for people to use the results.