New EBRI Research: Experts Differ on Possible Impact of Evidence-Based Consumer-Driven Medicine

8/14/2003

From: Jim Jaffe of the Employee Benefit Research Institute, 202-775-6353, jaffe@ebri.org

WASHINGTON, Aug. 14 -- Combining two proposed health insurance reforms - evidence-based medicine and consumer-driven plans - could help control costs while improving quality, if anyone could ever figure out how to do it right, leading experts on the topic conclude.

Their discussion of issues and possible answers is included in the August issue of Employee Benefit Research Institute's (EBRI) Notes, which summarizes the results of an EBRI-sponsored policy forum that occurred in May.

Speakers talked about the possible positive results from merging two trends in medicine:

-- Under consumer-driven health plans, the insured population has economic incentives to select providers who will deliver care that beneficiaries find cost effective.

-- Evidence-based medicine, which presupposes a movement toward having all providers use a preferred approach that has proven to be safe and efficacious, for a given diagnosis. In the past proponents of evidence-based medicine have devoted most of their attention to educating providers rather than patients.

While speakers at the forum agreed that the goal is a worthy one, many saw significant impediments to quickly achieving it. Patients often lack access to good data and tend to define quality differently than health-care professionals do.

There are also broader questions. The area of long-shot remedies is one of them. From a systemic point of view, it might not make economic sense to pay for a remedy that only has a one percent chance of success. But a patient lacking other options might decide it was worth taking the chance. So the question of allocating choices between patients and insurers would be a thorny one.

"Melding two such complex strategies won't happen overnight," said EBRI President and CEO Dallas Salisbury, "but a successful marriage of evidence-based medicine and consumer-driven plans could be a major step forward."