STATEMENT OF THE ASSOCIATION FOR
HEALTH SERVICES RESEARCH
TO THESUBCOMMITTEE ON LABOR, HEALTH AND
HUMAN SERVICES, EDUCATION AND RELATED AGENCIES
COMMITTEE ON APPROPRIATIONS
UNITED STATES HOUSE OF REPRESENTATIVES

PRESENTED BY
WILLIAM L. ROPER, M.D., M.P.H.
MARCH 7, 2000

Thank you, Mr. Chairman and Members of the House Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee, for the opportunity to present testimony on the critical role of health services research in improving our nation's health care. My name is William L. Roper, M.D., MPH, and I am Dean of the School of Public Health at the University of North Carolina at Chapel Hill (UNC). Prior to UNC, I served as Administrator for the Health Care Financing Administration from 1986- 1989 and as Director for the Centers for Disease Control and Prevention from 1990-1993.

Today I am representing the Association for Health Services Research (AHSR), a non-profit national professional association devoted to improving the health status of Americans through health services research. AHSR represents more than 2,800 individuals and 130 organizational members, including universities, insurers, providers, employers, and health plans that use and produce health services research information. I serve on the Board of the Association and was its President in 1996-1997.

I particularly want to thank the Subcommittee for its efforts over the past few years in support of federal funding for health services research. Health services research results are increasingly being utilized by every segment of the health care delivery system to improve care, expand access, and reduce costs. As a result, the need for increased funding for health services research has never been more imperative than now.

Last year, in our testimony before this Subcommittee, AHSR called for a major investment in health services research, requesting a tripling of funding for all federal health services research programs over the next five years. Recently the Association of American Medical Colleges has stated that funding for the premier Federal health quality agency, the Agency for Healthcare Research and Quality, should be quadrupled, or "billionized", to achieve dramatic improvements in our nation's healthcare delivery system.

Health services research serves as a critical resource for not only policymakers, but employers, insurers, providers and consumers. It improves what we know about health care and translates that information into clinical practice through the dissemination of information. This essential role of health services research has been recognized in every major piece of health legislation passed by Congress in recent years, including the Health Insurance Portability and Accountability Act (HIPAA), the Children's Health Insurance Program (CHIP), the Balanced Budget Act (BBA), the Balanced Budget Refinement Act (BBRA), and the Healthcare Research and Quality Act. This year the Congress has under active consideration managed care, Medicare reform, and the reduction of medical errors. It was, in fact, the important early funding support of research on errors in medicine, particularly system errors, by the Agency for Healthcare Research and Quality that led to and provided the basis of the recent Institute of Medicine report, To Err is Human: Building a Safer Health System.

The demand for health services research information and the need to improve our health care system cannot and will not be effectively met without the continued leadership of this Subcommittee and the Congress. We urge you to seize the opportunity this year to make a substantial difference in health care and in the public's health by investing even more strongly in health services research.

IMPROVING HEALTH CARE QUALITY
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

The Agency for Healthcare Research and Quality (AHRQ) is the lead Public Health Service agency focused on health care quality. AHRQ's research provides the evidence-based information needed by consumers, providers, health plans, purchasers, and policymakers to make informed health care decisions. Last year Congress reauthorized and renamed the Agency to reflect its public and private sector leadership in supporting research to improve health care quality and strengthened the Agency's role with regards to several Congressional initiatives, including coordinating all Department of Health and Human Services health care quality initiatives.

For the past two years, this Committee has provided funding increases of $25 million and $34 million, respectively. We are appreciative of this support as AHRQ has been able to:

* Significantly increase the number of new grants available for outcomes, quality, and primary care research. In 1997, AHRQ sponsored only 10 new grants. This number will grow to an anticipated 86 new projects in FY2000. However, the success rate for grants remains low in comparison with other research agencies. The Agency will support approximately 16% of reviewed applications in FY2000.

* Expand private-public partnerships. AHRQ's Evidence-based Practice Centers (EPCs) and new primary care practice-based research networks (PBRNs) are model programs for joining physicians, health plans, employers and researchers together to address prevalent health conditions. In FY2000, AHRQ will fund 12 EPC studies and 14 PBRNs.

* Fulfill the Congressional mandate to reduce adverse drug events. Four Centers for Education and Research in Therapeutics (CERTs) will be funded in FY2000 to carry out the agency's new authority for increasing awareness of appropriate uses of drugs, biologics and devices.

FY2001 Budget

The Agency's achievements in the last two years demonstrate the need for continued strong funding support for AHRQ, but few have captured public and Congressional attention more than the recent Institute of Medicine (IOM) on medical errors. The report, which estimates that as many as 44,000 to 98,000 people die each year because of medical errors, recommends $30-35 million for the Agency to establish a National Center for Patient Safety and take immediate steps to reduce medical errors, including research to improve health information systems. AHRQ has taken the lead in spearheading errors reduction research and in coordinating the Department of Health and Human Services response to the report. The President's FY2001 budget includes $20 million for this effort in AHRQ. AHSR supports increased funding of $30-35 million for AHRQ as recommended by the IOM.

AHRQ's public-private partnerships, prevention research and investigator-initiated grants facilitate the translation of research into clinical practice and disease management strategies, specifically addressing the needs of vulnerable populations such as persons with chronic conditions, the uninsured, women, children, and the elderly. The President's budget request does not sustain the growth of the last two years in new awards and grants, leaving a deficit of disease and chronic illness study areas. AHRQ also currently relies heavily on its partners and its web sites to disseminate critical health decision information. Additional resources are needed by the Agency to better meet consumer, employer and provider demands for information on health care quality and outcomes.

Recommendation: AHSR respectfully requests a FY2001 budget of $300 million for AHRQ to ensure continuation of the critical disease management and prevention research made possible by the funding increases provided in the last two years as well as to fully address the urgent need to reduce errors in medicine.

HEALTH CARE FINANCING ADMINISTRATION

The Office of Strategic Planning (OSP) guides the development and implementation of new health care financing policies and evaluates their impact on Medicare and Medicaid beneficiaries, participating providers, and States. HCFA's responsibilities for implementation of significant portions of HIPAA, CHIP, BBA, and now BBRA have put tremendous burdens on OSP. Last year Congress provided a $13 million increase for OSP, the Office's first increase in several years. The President's request for FY2001 would reduce current year funding by nearly $7 million.

Recommendation: AHSR recommends an additional $5 million in funding above OSP's FY2000 budget, representing a $13 million increase over the President's request and a total FY2001 budget of $68 million.

CENTERS FOR DISEASE CONTROL AND PREVENTION

The Centers for Disease Control's National Center for Health Statistics (NCHS) is the Federal government's principal vital and health statistics agency. In recent years, the Center has been given unprecedented responsibilities by Congress in assisting the Secretary of Health and Human Services in the implementation of the electronic data transfer provisions of the Health Insurance Portability and Accountability Act. NCHS provides the data and facts needed to track changes in health and health care and identify health problems, risk factors, and disease patterns.

Recommendation: AHSR supports the President's request of $110 million for NCHS, representing a $5 million increase over FY2000.

NATIONAL INSTITUTES OF HEALTH

The National Institutes of Health provides significant funding for health services research primarily through the National Institute of Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), the National Institute on Mental Health (NIMH), and the National Library of Medicine (NLM). These programs, through their innovative, treatment-focused efforts, are excellent examples of health services research's direct impact on improved patient care.

National Institute of Alcohol Abuse and Alcoholism

NIAAA is pursuing a three-prong approach that relies upon research, prevention, and treatment to address the impact and effects of alcoholism in America. Outreach is a key component of each facet of this strategy, including raising public awareness about alcohol disorders and treatment, improving clinician diagnosis and treatment skills, and integrating prevention and treatment techniques into medical school curricula.

National Institute on Drug Abuse

As part of its mission to treat and prevent drug abuse and addiction, NIDA has traditionally supported the development of research-based treatment protocols and prevention models. While these programs have proved to be highly successful under the constructs of carefully controlled clinical trials, NIDA faces new challenges in integrating these protocols in real-life treatment settings. The Institute's health services research portfolio has enabled the Institute to assist treatment and prevention providers to gauge program effectiveness and make the adjustments necessary to improve patient care.

National Institute of Mental Health

NIMH's health services research programs have focused on the transfer of knowledge about the diagnosis and treatment of mental health into practical interventions for conditions such as schizophrenia, depression, anxiety, and eating and attention deficit disorders. The Institute has increased its emphasis on mental disorders affecting children with new outreach programs addressing youth violence, suicide, mood and anxiety disorders, and autism.

National Library of Medicine

NLM is the foremost source of health and health services research information in the world, providing quick access to health information to millions each year. These services increasingly are provided through the Internet, making further development of this mode of information dissemination key to future improvements in health care, health education, and medical research. AHSR supports NLM's efforts, in working with the National Science Foundation and others, to ensure the Next Generation Internet meets the demands of medical applications and research. AHSR also supports the Library's efforts, along with other Federal health agencies, to ensure the quality of health information available to consumers, providers, and purchasers on the Internet.

Recommendation: AHSR supports the President's overall budget request of $18.8 billion, or a 5.6 percent increase, for the National Institutes of Health and, in particular, for NIAAA, NIDA, NIMH, and NLM.

NEED FOR FEDERAL FUNDING

Mr. Chairman, AHSR appreciates your leadership and support of health services research during your tenure on the Committee and in Congress. We were pleased to have acknowledged this leadership with our President's award in 1998 which we presented to you for your continued efforts to strengthen and improve our nation's health care system through enhanced funding for health services research. We urge you and the Subcommittee to continue the progress made during the last two years by providing a substantial investment in Federal health services research programs in the FY2001 appropriations. We thank you for your consideration of our request and for this opportunity to testify before the Subcommittee.