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 W. DAVID HELMS, Ph.D.
CHIEF EXECUTIVE OFFICER

APRIL 21, 1999

Thank you, Mr. Chairman and Members of the House Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee, for the opportunity to testify on the role of health services research in improving our nation's health care. The Association for Health Services Research (AHSR) is the only 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, major employers, and health plans that both use and produce health services research information.

I am particularly pleased to be here today, Mr. Chairman, to thank you for your efforts and the efforts of the Subcommittee over the past few years in support of federal funding for health services research. Your continued support of a strong federal funding commitment to health services research is more critically important than ever before. Health services research results are increasingly being used by every segment of the health care delivery system to respond to demands for improved care, expanded access, and reduced costs. These demands cannot and will not be effectively met without the continued strong support of this Subcommittee and the Congress for funding of health services research.

Our nation’s biomedical research enterprise has made tremendous advances in disease detection and treatment in the last fifty years. In recent years these advances have been related to strong congressional support of significant funding increases for the National Institutes of Health. We can all take pride in the contributions biomedical advances have made to our nation’s health care. It is important to remember, however, that in the health research continuum, health services research begins where biomedical research ends. Advances in biomedical research are incomplete without science-based quality and cost research and evaluation. Health services research complements biomedical advances by translating these advances into delivery of care at the organizational and individual levels. Improving what we know about health care through enhanced research efforts and translating that information into clinical practice through the dissemination of information to consumers, providers, employers, and health plans is the next critical step to ensuring patients do not just have access to care, but receive appropriate, quality care.

Some may view health services research as "academic", but please understand that it provides the information and tools we need to be sure our best medical knowledge and technology are applied directly to improve people’s lives. All major health legislation passed by Congress in recent years (e.g., the Health Insurance Portability and Accountability Act and the Children’s Health Insurance Program) as well as that under current consideration has and will use health services research findings to make the health care system work better for patients as we strive to improve how we organize, finance, and deliver the care needed by the American people.

AHSR understands the budget constraints facing the Subcommittee, and therefore, our FY2000 funding recommendations are made within those restrictions. However, our organization would be remiss in leading the Subcommittee to believe that this level of funding is sufficient. A major investment, along the lines of tripling funding for federal health services research programs over the next five years, is needed to make real differences in improving health status and health care. AHSR looks forward to working with you to achieve the complementary goals of increased federal funding for health services research and improved health care.

ADVANCING QUALITY HEALTH CARE

The federal government provides funding for health services research through a consortium of federal health science agencies. Each of these agencies plays an important role in influencing health care delivery and brings 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) is the lead agency within the Public Health Service that supports and disseminates research to improve outcomes and quality of health care. AHRQ’s research provides the evidence-based information needed to determine appropriate disease management strategies, make informed health care choices, and improve the cost-effective use of health resources.

Last year this Subcommittee approved a $25 million increase for AHRQ. This funding has enhanced the agency’s ability to:

• Significantly increase the number of grants available for improving outcomes and quality and especially for determining effective disease treatment and management strategies for vulnerable populations such as persons with chronic conditions, the uninsured, children, and the elderly.

• Expand private-public and interagency partnerships, including the Evidence-based Practice Centers, which provide a forum for physicians, health plans, employers and researchers to come together in addressing prevalent health conditions, and joint initiatives with the National Institutes of Health and other federal agencies.

These partnerships are critical to the dissemination and adoption of research findings and ensure that even studies funded primarily through other Federal agencies and private organizations contain the health services research focus necessary to fully evaluate or assess a program’s or treatment methodology’s effectiveness in improving care.

• Fulfill the Congressional mandate to designate Centers for Education and Research on Therapeutics to increase awareness of the appropriate uses of and to reduce adverse events from the use of pharmaceuticals and other interventions.

• Evaluate how system improvements can prevent errors in medicine.

• Further strengthen collaboration with employers and provider and consumer organizations in translating scientific discoveries into clinical practice and prevention strategies into disease management treatment.

Each of these areas is critical to our nation’s efforts to make a real difference in improving health status and quality of life for our citizens. AHRQ’s resources, however, remain far outweighed by research needs. While the FY99 increase provided by the Subcommittee significantly bolstered the agency’s ability to carry out its mission, the agency’s relatively small budget continues to leave a deficit in disease and chronic illness study areas.

Recommendation: AHSR strongly believes that the health services research activities of AHRQ must be further strengthened and urges the Subcommittee to support an additional $19 million above the President’s request for a FY2000 budget of $225 million.

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 the Health Insurance Portability and Accountability Act, the Child Health Insurance Program, and the Balanced Budget Act of 1997 have put tremendous burdens on OSP in terms of accessing the impact of these programs on beneficiary access, satisfaction, and care. It is particularly disturbing that in FY1999 OSP was only able to fund $6 million in new initiatives. Congress must provide OSP additional funding support if the Office is to fully carry out its research mission.

Recommendation: AHSR recommends an additional $15 million in funding above OSP’s FY1999 budget, representing a $10 million increase over the President's FY2000 request and a total FY2000 budget of $65 million.

National Institutes of Health

While the Committee is no doubt familiar with the biomedical and clinical research performed at the National Institutes of Health (NIH), the Institutes also provide 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 of consumers, providers, employers, health plans, researchers, and Federal and State agencies and policymakers 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.

Recommendation: In light of the increases provided by Congress in recent years, AHSR is concerned that the modest increase proposed in the President’s FY2000 budget is insufficient to maintain current research programs at NIH. AHSR recommends continued funding support for NIH, and specifically for NIAAA, NIDA, NIMH, and NLM, at levels that enable the Institutes to not only continue their important biomedical and clinical research, but also to support their much needed health services research agendas.

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 substantiate and measure the effectiveness of CDC’s prevention programs and to prioritize Federal research efforts.

Recommendation: AHSR supports the President's request of $110 million for NCHS.

NEED FOR FEDERAL FUNDING

Mr. Chairman, the Association for Health Services Research is particularly concerned that the rallying cry for improving the quality of health care will ring hollow unless it is coupled with a clear and unequivocal commitment to a strong federally funded health services research program. Quite simply, we will not achieve optimal quality in our nation’s health care without a body of evidence-based science to guide decisionmaking. The degree to which that body of evidence is available to support and guide improvements in health care will depend directly on the level of federal funding support for health services research.

Mr. Chairman, we thank you and the Subcommittee for its consideration of our testimony and urge you to provide this important funding support in the FY2000 appropriations. Additionally, we look forward to working with you to establish a long-term commitment for tripling federal health services research funding over the next five years.