OPINION - Giving teeth to comparative-effectiveness research - the Oregon experience

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Giving Teeth to Comparative-Effectiveness Research — The Oregon Experience

Posted by NEJM • 03 February 2010

Somnath Saha, M.D., M.P.H., Darren D. Coffman, M.S., and Ariel K.

Smits, M.D., M.P.H.

Experts believe that comparative-effectiveness research (CER) can

substantially reduce future health care spending and improve the

quality of care.1,2 Their analyses indicate that CER can control costs

if its results are used to inform coverage, payment, and cost-sharing

policies that provide incentives for appropriate and cost-effective

care.1,2 But the proposed approach to CER in the United States would

constrain these uses of the research, to avoid any implication that

health care will be rationed. Though the word elicits fear and

opposition, “rationing” is simply the equitable, or rational,

distribution of resources; it involves delivering health care services

according to clinical need and effectiveness, rather than wealth or

geographic location.

True, rationing involves setting limits, and some Americans believe

that when it comes to health, the resources available to doctors and

patients should be unlimited. This position is facilitated by our

insurance model, which insulates patients from the cost of care and

rewards physicians for doing and spending more, even when the benefit

is marginal or unproven. But there is ample evidence that in many

communities, we overconsume health care, with adverse consequences for

our economic and physical well-being.3 CER can help in shaping a menu

of tests and treatments that optimize health while minimizing waste.

But first we must get over our fear of the “R” word.

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Read the full article here:

http://healthcarereform.nejm.org/?p=2936 & query=TOC

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