By Robert Wachter, MD
Thanks to White House budget director Peter Orszag, a Dartmouth Atlas aficionado, .1 billion found its way into the stimulus piñata for “comparative effectiveness” research. Terrific, but – to paraphrase Jack Nicholson – can we handle the truth?
In other words, are we mature enough to use comparative effectiveness data to make tough decisions about what we will and won’t pay for? I worry that we’re not.
First, a bit of background. Our health care system, despite easily being the world’s most expensive, produces (by all objective measures) relatively poor quality care. Work begun 3 decades ago by Dartmouth’s Jack Wennberg and augmented more recently by Elliott Fisher has made a point sound-bitey enough for even legislators to understand: cost and quality vary markedly from region to region, variations that cannot be explained by clinical evidence and do not appear to be related to health care outcomes. In other words, plotting a 2x2 table with costs on one axis and quality on the other, we see a state-by-state Buckshot-o-Gram.
Three key conclusions flow from this “variations research”:
Since nothing can happen without the research, the new funding for comparative effectiveness is welcome and helpful. But will it be sufficient to move the needle?
http://www.thehealthcareblog.com/the_health_care_blog/2009/02/are-we-mature-enough-to-make-use-of-comparative-effectiveness-research-.html