STATEMENT OF THE
ASSOCIATION FOR HEALTH SERVICES RESEARCH

TO THE

SUBCOMMITTEE ON LABOR,
HEALTH AND HUMAN SERVICES,
EDUCATION AND RELATED AGENCIES
COMMITTEE ON APPROPRIATIONS
UNITED STATES HOUSE OF REPRESENTATIVES

PRESENTED BY JACK HADLEY, Ph.D.
PROFESSOR OF HEALTH SERVICES RESEARCH, GEORGETOWN UNIVERSITY INSTITUTE FOR HEALTH CARE RESEARCH AND POLICY

FEBRUARY 5, 1998

Thank you, Mr. Chairman and Members of this Subcommittee, for the opportunity to testify on the role of health services research in improving our nation's health care. I am Jack Hadley, professor of health services research as the Georgetown University Institute for Health Care Research and Policy. It is in my capacity as President-elect of the Association for Health Services Research (AHSR) that I appear before you today.

AHSR is a non-profit organization and the only national professional association devoted to improving the health status of Americans through health services research. AHSR represents more than 2,800 individuals who use and produce health services research and approximately 140 organizational members, including universities, insurers, providers, major employers, and health plans.

I am particularly pleased to be here today, Mr. Chairman, to thank you for your efforts and the efforts of this Subcommittee over the past few years in support of federal funding for health services research. Just as federal funding of biomedical research is essential to developing new treatments for disease, a continued strong federal commitment to health services research is needed to ensure that these discoveries are appropriately translated into the delivery of quality health care. By evaluating the effectiveness of health care and the ability of the health care system to deliver these services efficiently, health services research aids in the transfer of science from the laboratory into practical use by physicians and hospitals -- essentially speeding the integration of biomedical research into patient care and disease prevention.

Health services research also plays a critical role in educating consumers and purchasers about the care they receive, serving as a resource not just for disease treatment and prevention information, but also providing information, such as quality data for health plans, that enables consumers to better choose their health care. Furthermore, by examining the impact of the delivery and financing of health care on access and quality, health services research provides the evidence needed by policymakers to better determine health care priorities, particularly among vulnerable populations and within the Federal health Medicare and Medicaid programs.

Demand for health services research among consumers, employers, providers, health plans, and policymakers has never been greater. As our nation’s health care marketplace continues to become more sophisticated and more complex, health services research has become an essential resource for making informed decisions about how to deliver needed care efficiently. The goal is to identify which treatments work best for which patients and to assess the relative cost of those treatments so that health care providers and patients can make informed decisions about what regimens to choose.

ADVANCING THE ROLE OF HEALTH SERVICES RESEARCH

Our country is the world’s leader in making some of the most remarkable and life-enhancing medical discoveries ever known. Integrating these discoveries into health care delivery requires a collaborative effort, particularly among the federal government’s health research agencies. Health services research is not an activity about which one can say that if the federal government does not do it, the private sector and perhaps a state and local government will step in. Lack of federal support will mean a chronic under investment in health services research to improve the quality of health care. Each of the agencies plays an important role in influencing the delivery of health care in America and bring its own contributions or tools to the health care quality equation.

Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) serves as the focal point within the federal government for determining what works best in health care. The President has recommended an increase of $25 million for AHRQ, or a total FY99 budget of $171 million. These new funds will allow AHRQ to carry out several new directives recently mandated by Congress, including:

• Continued research on improving the quality of care for Medicare and Medicaid beneficiaries, the uninsured, and children, focusing particularly on improving the management of chronic conditions such as congestive heart failure and osteoporosis,

• Support for the Congressional initiative, the Children’s Health Insurance Program, by providing scientific evidence on how to improve quality care for uninsured children,

• The establishment of centers for education and research, as authorized in the Food and Drug Administration Modernization Act, to increase the awareness of new uses and the risks of drugs and other medical products,

• Full implementation of the agency’s private sector initiatives, including the Evidence-based Practice Centers, which provide a forum for physicians, health plans, employers, and researchers to work together in addressing prevalent and costly health conditions in American society, and

• Increased awareness of the preventive care recommendations of the U.S. Preventive Services Task Force to encourage screening and immunizations.

Recommendation: Recognizing Congress’ interest in improving health care quality, AHSR strongly believes that the health services research activities of AHRQ must be even further strengthened with additional funding. AHSR urges the Subcommittee to support an additional $4 million for AHRQ for a total FY99 budget of $175 million.

Health Care Financing Administration

The Health Care Financing Administration’s research arm, the Office of Research and Demonstrations (ORD), guides the development and implementation of new health care financing policies and evaluates their impact on Medicare and Medicaid beneficiaries, participating providers, and states. ORD plays a critical role in creating a better understanding of how well the Medicare and Medicaid programs are performing in terms of access, quality, efficiency, costs, and beneficiary satisfaction and in how to further improve program performance.

Recommendation: AHSR supports the President's FY99 funding request of $50 million for the Health Care Financing Administration’s Office of Research and Demonstrations.

National Institutes of Health

As the foremost biomedical and behavioral research institution in the world, the National Institutes of Health (NIH) also provides significant funding for health services research. While many Institutes fund health services research, NIH primarily supports health services research through:

• Prevention and treatment programs of the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA),

• Studies on risk factors and cost-effective mental health care of the National Institute on Mental Health (NIMH), and

• Information dissemination activities of the National Library of Medicine (NLM).

Recommendation: AHSR supports the President's FY99 budget request for a $1.1 billion increase for the National Institutes of Health and, specifically supports the increases proposed for NIAAA, NIDA, NIMH, and NLM.

Centers for Disease Control and Prevention

CDC's National Center for Health Statistics (NCHS) is the nation's principal vital and health statistics agency, conducting ongoing studies to meet the nation's health information needs. These tools provide the basis for research at AHRQ and NIH on specific diseases or within certain populations.

Recommendation: AHSR supports the President's request of $86 million for NCHS.

Conclusion

The most important message I could leave with you today is that a Congressional promise to the American people to improve the quality of health care will be difficult to keep unless it is coupled with increased health services research funding. We can not improve quality without a body of evidence-based science to guide clinicians and public and private policymakers about what works best and how to create systems to deliver good quality care at acceptable cost. The degree to which that body of evidence is available and the extent to which we succeed in achieving quality improvement in health care will depend directly on the level of funding support that is made available for health services research.

Thank you again for the opportunity to present this testimony.