April 18, 2003

The Honorable Ralph Regula
Chairman
Subcommittee on Labor, Health and
Human Services, Education and
Related Agencies
2358 Rayburn House Office Building
Washington, DC 20515

Dear Chairman Regula:

The Coalition for Health Services Research (Coalition), representing over 3,750 members and 125 organizational affiliates, thanks you for your continued support of health services research - the research that examines how people get access to health care, how much health care costs, and what happens to patients as a result of such care. Health services research is used by policymakers, health administrators and providers to improve care and services. Current and future health services research is addressing the most critical health policy issues facing our country: reducing medical errors, making the best use of information technology, and translating bench research into medical practice.

While the Agency for Healthcare Research and Quality is the principal agency conducting and supporting health services research, other agencies play a critical role in the development of health services research. The Centers for Medicare and Medicaid Services' Office of Research, Development and Information, the Center for Disease Control and Prevention's National Center for Health Statistics and its extramural prevention research program, and the National Library of Medicine's National Information Center on Health Services Research and Health Care Technology are important as well, but have seen their budgets remain flat or shrink over the past five years.

• Under the President's proposed FY2004 budget, the Agency for Healthcare Research and Quality (AHRQ), currently funded at $304 million, would be reduced to $279 million - a cut of over 8 percent. If this budget were enacted AHRQ will be unable to award any new non-patient safety grants in FY2004. Also, current non-patient safety grants would need to be cut by 15 percent.

The Coalition urges a funding level of $390 million to ensure adequate funding for high priority research needs including: understanding the causes of and solutions to medical inflation; promoting improvements in health care quality; strengthening efforts to translate research into practice; and increasing appropriate access to medical technology.

• After having their budget reduced from $55.3 million (in non-earmarked funds) to $28 million, the Centers for Medicare and Medicaid Systems (CMS) Office of Strategic Planning will see their research budget cut again to $23 million. After paying for the Medicare Beneficiary survey, and other statutory requirements, CMS will not have enough to fund current projects.

The Coalition supports a funding level of $60 million to ensure that CMS can meet its current obligations and expand research into areas such as quality care for those with chronic illnesses; plan and beneficiary participation in managed care; approaches to educating beneficiaries through use of the Internet (e-health); and the impact of technological changes on Medicare and Medicaid.

• The National Center for Health Statistics (NCHS) plays a crucial role in health services research by collecting the data needed in many important research areas including the status of America's health. This data is also used to measure the impact and effectiveness of health policies and programs. The NCHS budget has remained flat for several years. The President's proposed budget of $125 million is actually a reduction of $1 million from this year's funding level of $126 million. Without an increase, we run the risk of losing not just the timeliness of the data, but some critical elements of the data set as well.

The Coalition recommends a budget of $180 million for NCHS. This increase will allow them to maintain their current surveys and begin an investment in improving their technology, allowing them to collect more accurate data in a more timely fashion.

• The Centers for Disease Control and Prevention's (CDC) $18 million extramural prevention research budget - the only extramural health services research program at the CDC - is once again proposed to be eliminated by the President's budget. CDC developed this program to move knowledge about effective strategies for preventing disease and disability from research to implementation in diverse community practices and programs. The program uses a model of community-based participatory prevention research, and has supported over 50 projects based in states and localities throughout the country. Congress restored this program in its FY2003 appropriations. Eliminating the program in FY2004 would, in essence, waste the FY2003 appropriations since the second round of projects is just beginning.

The Coalition recommends continuing this program at the current appropriation of $18 million.

• While the National Library of Medicine has seen its budget increase along with the other institutes at the National Institutes of Health, its National Information Center on Health Services Research and Health Care Technology (NICHSR) has seen its budget remain static since its original appropriation in FY1993 of $8 million (current budget $8.2 million). NICHSR currently works to improve the dissemination of research, focusing on evidence reports and technology assessments.

The Coalition recommends Increasing funding for the NICHSR to $10 million to allow NICHSR to expand coverage of the Healthy People 2010 Information Access Project (phpartners.org/hp). This program is designed to make it easier to find information on evidence-based strategies related to meeting the Healthy People 2010 objectives as well as other public health projects.

In a time of rising health care costs and increasing numbers of uninsured, we should be increasing, not cutting, the federal government's investment in the research that the public and private sectors will need to address these challenging health system problems. We urge your support for increased research funding.

Sincerely,

W. David Helms, Ph.D.
President and CEO