Researchers and economists are concerned that the Innovation Center, a research group housed at the Centers for Medicare and Medicaid Services and allotted $10 billion through the Affordable Care Act, is not using the kind of randomized clinical trials needed to evaluate how to deliver healthcare effectively.
Random clinical trials are the method typically used to evaluate medical and social science research, reports The New York Times.
"It's the greatest irony," said Gordon Berlin, president of MDRC, whose studies influence policies on job training, welfare, and education. Groups that evaluate medical evidence say randomized clinical trials are the most reliable method, he noted.
"The results speak volumes about the path not taken," said Berlin. "An extraordinary body of evidence has been built to inform welfare policy and practice while we have only just begun the process of learning what works in health policy."
With randomized clinical tests, researchers assign two groups of people or institutions randomly to participate in a program, and then compare the outcomes between the two groups.
The Innovation Center instead uses demonstration projects which test an idea with all of the study's participants and then relies on mathematical models to evaluate the results. The center currently has about 40 such research projects underway, The Times reports.
Center Director Dr. Patrick Conway said the method allows his researchers to evaluate Obamacare programs and adapt them.
"Does it look like it is working?" he asked. "If it does not look like it is working, we can stop."
Studies so far have not yielded solid results, said Conway, because many of those in the control groups are not yet getting the programs that are being tested and tend to drop out.
Randomized trials in social policy follows a particular route, said Robert Boruch of the University of Pennsylvania's Wharton School.
"One of the typical events is a trial that serves as a benchmark, a precedent to show these things are useful," he said. It often takes several years after initial clinical trials for randomized studies to start, he noted.
Already, a randomized study financed by the National Bureau of Economic Research, overturned one Obamacare assumption, that insured people would use emergency rooms less. However, a ScienceMag.org
study shows that Medicaid recipients use emergency rooms more.
Critics also say that the Innovation Center's research is one-sided, reports The Times.
"A lot of money is being spent," said Jon Baron, president of the Coalition for Evidence-Based Policy
, but the Innovation Center's research methods are "not going to provide credible answers."
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