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Americans Wary of Government Payment Decisions on Health Care

By Rebecca Adams, CQ HealthBeat Associate Editor

December 22, 2011 – A poll released by the Harvard School of Public Health found that 67 percent of Americans believe the government or health insurers refuse to pay for expensive treatments because of cost, while only 38 percent of people in the United Kingdom say that's the case in their country, even though some in the United States have criticized the British system as one that rations care.

The poll, which surveyed more than 2,500 people in four nations, including 1,017 Americans, found that Americans were more skeptical about the idea of government involvement in decision-making about health treatments than respondents in the United Kingdom, Italy or Germany. About 34 percent of Americans said they trust the federal government's decisions on health care, compared to 54 percent of respondents in Britain and Italy and 42 percent in Germany.

In the United States, the 2010 health care law (PL 111-148, PL 111-152) created a lively debate about the role of government in health care decisions. A nonprofit created in the 2010 law, known as the Patient-Centered Outcomes Research Institute (PCORI), became a lightning rod during the congressional debate because it funds research that compares different treatments for the same condition. Republicans and some advocacy groups said that the findings of studies financed by PCORI could be used by the federal government to deny coverage under Medicare, Medicaid, and other health programs for less effective or more costly services, even if they work for some people.

Joe Selby, the executive director of PCORI, said on a recent phone briefing about the poll that PCORI is most interested in studies that compare the clinical effectiveness of similar treatments rather than their relative cost-effectiveness.

Selby said that the group "is not setting out to find comparisons where one is more costly and one is less" and use that information to deny patients the more costly care. He said that cost may be one factor that research funded by PCORI considers, but that the emphasis will be in trying to figure out which treatments work the best and which types of patients benefit the most from various treatments.

The phone briefing was organized by the Alliance for Aging Research, which commissioned the poll. The British respondents were not asked to differentiate between the care they get under the national health system and the care received under any private health insurance they might also have.

Selby was asked by the Alliance for Aging Research president and CEO Dan Perry whether research that compares various treatments might end up hurting innovation, because a company might fear investing millions in creating a treatment but finding that if it does not outperform existing treatments, the federal government and health insurers might decide not to pay for it.

Selby said he has the opposite view.

"I think a lot of people in industry have come around to see it in this converse way as well," said Selby. "What taking a more comparative perspective might do is dampen incentives to create 'me, too' type drugs that have about the same benefits and can be sold at higher prices." But if companies can identify a subpopulation of patients who benefit more from a new drug than an existing drug, Selby said, comparative effectiveness research "actually is a boon to innovation, because it helps us understand where we want to go."

PCORI was controversial in the beginning, but since its creation, the institute's leaders have taken a low profile and have funded a relatively small number of studies so far, none of which have sparked a debate.

The poll did not ask about PCORI specifically but provided information about how people in different countries seem to view their health care coverage and the role of government in making decisions about which treatments to pay for.

Americans reported being less satisfied with the nation's health care system than British or German respondents. About 38 percent of Americans were very or fairly satisfied with the overall health care system. That compared to 68 percent of the British, 52 percent of Germans, and 40 percent of Italians (although 14 percent of Americans said they were "very" satisfied, compared to 5 percent of Italians).

Americans were the most skeptical about the idea of government involvement in decision making about health treatments. About 54 percent of Americans who responded said they would oppose having a government entity decide whether government programs should pay for treatments based on cost, while 48 percent of Britons, 23 percent of Italians and 21 percent of Germans had a similar response.

The poll was conducted in June and July. The sampling error among U.S. respondents is 3.9 percent, while the sampling error was 5.4 percent for the Britons, Italians and Germans surveyed.

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