¶ … Medical Treatments: Issues and Options for an Expanded Federal Role" Using Bardach's Eightfold Path"
The objective of this work in writing is to assess the work entitled "Research on the Comparative Effectiveness of Medical Treatments: Issues and Opinions for an Expanded Federal Role" using Bardach's Eightfold Path.
Bardach's eightfold path includes specific steps for assessment including: (1) Defining the problem; (2) assembling some evidence; (3) Construction of alternatives; (4) selection of criteria; (5) projection of the outcomes; (6) confrontation of the trade-offs; (7) decisions; and (8) telling the story.
Defining the Problem
The work entitled "Research on the Comparative Effectiveness of Medical Treatments: Issues and Opinions for an Expanded Federal Role" was published by the Congressional Budget Office in November 2007 and is focused on the rising health care costs and the challenge that these represent for the federal government and private payers alike. It is noted in this work that there is a "variety of evidence" suggesting that there are existing opportunities to "constrain health care costs both in the public programs and in the rest of the health system without adverse health consequences." (GAO, 2007)
II. Assembling Some Evidence
Federal spending on Medicare and Medicaid is noted to have increased and in fact tripling "over the past 30 years…as a share of gross domestic product (GDP), rising from about 1.3% in 1975 to about 4% in 2007." (GAO, 2007) If the costs per enrollee stay on the path of growth over the next four years as they have in the previous four "then federal spending on those programs would reach about 17% of the economy." (GAO, 2007) It is reported that evidence concerning which treatments are most effective for which patients is many times not available.
III. Construction of Alternatives
Alternatives stated to be available by the Congressional Budget Office includes the following:
(1) Because any private...
In choosing an organizational arrangement and a mechanism to provide federal funds to it, tradeoffs could arise between the entity's independence from political pressure and its accountability to policymakers and other interested parties. Efforts to bolster comparative effectiveness research would be more likely to change medical practice if the organization coordinating the research was respected and trusted by doctors and other professionals in the health sector. The level of funding required for a new or augmented entity would depend largely on what its additional activities involved. Synthesizing existing studies or analyzing available data on medical claims would be less expensive than conducting new head-to-head clinical trials to compare treatments but could also yield less definitive results -- and therefore might have a smaller impact on medical practice.
(4) Clinical trials could be more persuasive but also more time-consuming, and there is probably a limit to how many comparative trials could be undertaken effectively at any given time. If privacy concerns could be addressed, having more health records available in electronic form would facilitate the…
