WASHINGTON (AP) —Starting this new year, the government is charging a new fee to your health insurance plan for research to find out which drugs, medical procedures, tests and treatments work best. But what will Americans do with the answers?
The goal of the research, part of a little-known provision of President Barack Obama's health care law, is to answer basic questions such as whether that new prescription drug advertised on TV really works better than an old generic costing much less.
But, in the politically charged environment surrounding health care, the idea of medical effectiveness research is eyed with suspicion. The insurance fee could be branded a tax and drawn into the vortex of election-year politics.
The Patient-Centered Outcomes Research Institute — a quasi-governmental agency created by Congress to carry out the research — has yet to commission a single head-to-head comparison, although its director is anxious to begin.
The government is already providing the institute with some funding: The $1-per-person insurance fee went into effect Sunday but the Treasury Department says it's not likely to be collected for another year, though insurers would still owe the money. The fee doubles to $2 per covered person in its second year and thereafter rises with inflation. The IRS is expected to issue guidance to insurers within the next six months.
“The more concerning thing is not the institute itself but how the findings will be used in other areas,” said Kathryn Nix, a policy analyst for the conservative Heritage Foundation think-tank. “Will they be used to make coverage determinations?”
The institute's director, Dr. Joe Selby, said patients and doctors will make the decisions, not his organization.
“We are not a policy-making body; our role is to make the evidence available”' said Selby, a primary care physician and medical researcher.
But insurance industry representatives say they expect to use the research and work with employers to fine-tune workplace health plans. Employees and family members could be steered to hospitals and doctors who follow the most effective treatment methods. Patients going elsewhere could face higher copayments, similar to added charges they now pay for “non-preferred” drugs on their insurance plans.
Major insurers already are carrying out their own effectiveness research but it lacks the credibility of government-sponsored studies.
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