SHOULD YOU get surgery for your back pain or stick with physical therapy? When is heart surgery preferable to drug treatment? And which drugs should you take? Before too long, thanks to the Affordable Care Act, you might get some answers.
Doctors, hospitals and researchers often don’t have the information they need to gauge the effectiveness of one test or treatment against another — or against none. That’s one reason they order too many tests, prescribe too many drugs and encourage too many medical procedures. That wastes money — perhaps hundreds of billions of dollars every year — and exposes patients to unnecessary risks and side effects.
One little-heralded part of President Obama’s health-care reform law proposes to change that, possibly transforming medical practice for the better — but also probably inciting renewed political warfare over health-care “rationing.”
In July, the government began collecting a small tax on health insurers and sending the proceeds to the Patient-Centered Outcomes Research Institute (PCORI), an advisory committee tasked with ushering in a new era of medical care based on comparative effectiveness research — basically, rigorous review of what works and what doesn’t. The panel will have about $3 billion to spend through the end of the decade. One of PCORI’s latest grants went to set up a research network that will pull in data on patient experiences across the country, a task that could get much easier with the increasing use of digital medical records. Imagine thousands of data points on the fate of those who took one hypertension drug rather than another.
The concept is simple enough. The government should have delved into this sort of research with such ambition many years ago, as health-care costs rose steadily above inflation. Yet there are challenges. Maybe a treatment affects women differently from men, or the young more than the old. The statisticians will have to tease out those and other confounding effects. Results will not always be clear.
Even when they are, people will have to be convinced. Many will resist giving up a test or a drug they have come to trust, even if it’s proven ineffective. Consider the backlash when government researchers recommended that younger women stop getting regular mammograms. Doctors who make their living from certain treatments will warn of dire consequences to their patients’ health. That’s why financial incentives also will have to be reformed.
PCORI will encounter its share of political dogfights. Republicans will invoke the specter of government-imposed rationing. Some have already tried to ax the panel. Democrats will balk at the committee’s research as heartless number crunching. Removing ineffective treatment from the health-care system will be far from painless.
But the alternative — throwing money into the cash-gobbling health-care industry with little measurement or accountability — should be much less tolerable. In fact, the Affordable Care Act’s comparative effectiveness provisions don’t go far enough; the law bars the government from examining the cost effectiveness of medical practices in the most straightforward way. That analysis should at least be available for the public to consider.
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