It wasn’t advertised, but congress took the first step toward health care reform on Friday. The economic stimulus package includes $700 million for comparative effectiveness research (CE). This amount totals 9% of the spending bill. It may be some of the most effective money in the package.
Comparative Effectiveness Research (CE) is medical research that compares different treatments for a single disease to find out which ones work best. Sometimes the research takes cost into account. In November, the New York Times reported on a CE study that compared the effectiveness of blood pressure drugs. The study found that older, cheaper drugs called diuretics worked better than newer drugs to control blood pressure. That study was released in 2002, but the New York Times article noted that doctors had not changed their preferred treatments for high blood pressure. One reason was that drug makers increased their marketing for the more expensive (and profitable) drugs.
CE is useful because it can tell health care providers what works best, and how to get the biggest bang for the health care buck. Currently, most CE occurs when it would be unethical to give patients a placebo in a drug trial, for example, when testing a new AIDS drug.
The Congressional Budget Office (CBO) recommends using CE to help lower health care costs. Currently, the United States spends 16 percent of its gross domestic product on health care costs. The authors of the report expect this amount to increase to 20 percent by 2016. The government spends half of that money, so it has an interest in lowering costs.
The Alliance for Health Reform also recommend that the government engage in CE. Their report “Comparative Effectiveness: Better Value for the Money?” notes that insurance companies use CE to determine what treatments they will pay for.
When private companies conduct research on medical treatments, they often have an interest in the outcome. They sometimes have incentives not to perform head-to-head studies of treatments. The CBO report tells of a drug maker that tested its drug against a competitor, and found that the competitor’s product worked better.
Critics worry that the government will use CE to ration care. They worry that the government will tell doctors which treatments to use for their patients. Government interference is certainly undesirable, but it might be preferable to the current interference in health care decisions by insurance companies and drug makers. These critics overlook this kind of interference, and that it is based on profit motive.
Health care has been commercialized for far too long. The results are dreadful. Drug makers aggressively market the newest, most expensive drugs. Doctors operate on fee-for-service arrangements that reward them for ordering tests and procedures instead of for positive outcomes. Health insurance companies make money by paying for the fewest and cheapest procedures, and the patient is left to try to figure out the best course of action for him- or herself. Often, the patient must decide using the least effective criterion, price, as a guide.
Both John McCain and Barack Obama supported CE in their health care reform plans. President Obama has used the concept to create jobs. The stimulus package calls for research “that compares the clinical outcomes, effectiveness, and appropriateness” of treatments for disease. The research will include drugs, diagnostic procedures and surgeries and studies that compare published research about the effectiveness of treatments.
More research will create jobs and make more information available to doctors and patients. It will take time for the program to pay for itself, but it will benefit everyone who uses the health care system in the United States in the long run by lowering costs and promoting the best treatments. It’s about time that health care went back to being about what was best for the patient.
Andrew Pollack: “A Big Blood Pressure Study, and Its Minimal Impact on Drug Use.” New York Times (November 28, 2008). p. B1.
Congressional Budget Office. “Research on the Comparative Effectiveness of Medical Treatments” (December 2007).
Alliance for Health Reform. “Comparative Effectiveness: Better Value for the Money?”
H.R. 1 Conference Report. Thomas