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• W2240448788 abstract "Comparative effectiveness research will be the biggest thing to happen to American healthcare since the enactment of Medicare in 1965. (Trivia question: Who were the first two Medicare enrollees? Answer below.) For the first time in decades, we have a golden opportunity to transform a healthcare system whose costs are careening unsustainably out of control (enabled in part by Medicare, you could argue) into a system in which decision making is grounded in value.In a 2005 paper released by the National Institute of Health Care Management Foundation, Elliott Fisher, MD, PhD, of Dartmouth Medical School estimated that 30 percent of U.S. healthcare spending has no value. That’s 5 percent of the gross domestic product. Of course, one man’s waste is another man’s profit, so that conclusion is debatable — but, if you could total up the cost of overused, misused, under-used, or unused products, services, and administration in healthcare, I’m sure anyone’s number would be substantial.That’s where CER promises to pull off what even backers of evidence-based medicine have been unable to do: Establish which healthcare interventions have real value to the patient, and create an infrastructure for infusing that information into everyday practice. Ineffective, harmful, and perhaps even cost-inefficient drugs and procedures would be outed. And for those interventions with proven value, utilization would increase — and deservedly so.Unless you sell snake oil, that sounds great, doesn’t it? Yes, but if you are a buyer of healthcare (an employer, a union, the Department of Veterans Affairs, or a government entity), what do you take away from this to make better coverage decisions? If you are a third-party payer, how are you assured that the results of research into comparative effectiveness can be trusted?Two articles in this issue explore these questions. In our cover story, Senior Editor Katherine Adams reports that there is a place for manufacturers at the CER table, especially when they align their interests with those of policy makers and payers. Nobody says it will be easy, but there are common threads. As for employers, the lack of objective information demonstrating the relative benefit of various disease-specific treatments has prevented them from being able to make informed decisions, and outside of the largest employers, few have the expertise to understand the issues behind CE. But as Marc B. Royo of Jefferson Medical School notes in these pages, employers may benefit from CER if the rapid emergence of biologics, economic pressures, and diminishing returns from generic drug utilization combine to force a new wave of consumerism in healthcare.Oh, and that trivia answer? Harry and Bess Truman were first in. Lyndon Johnson personally enrolled them the day he signed Medicare into law." @default.
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• W2240448788 date "2009-08-01" @default.
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• W2240448788 title "The biggest thing since medicare." @default.
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