Financial Anatomy of Biomedical Research
By Hamilton Moses III, MD; E. Ray Dorsey, MD, MBA; David H. M. Matheson, JD, MBA; Samuel O. Thier, MD
JAMA
September 21, 2005
The United States spent an estimated 5.6% of its total health expenditures on biomedical research, but less than 0.1% for health services research.
Biomedical research funding increased from $37.1 billion in 1994 to $94.3 billion in 2003. Principal research sponsors in 2003 were industry (57%) and the National Institutes of Health (28%).
The federal government and foundations spent $1.4 billion on health policy research and health services research in 2002. Federal funding for health services research came primarily from the NIH ($787 million in fiscal year 2002) and the Agency for Healthcare Research and Quality ($299 million in fiscal year 2002). The Robert Wood Johnson Foundation accounted for nearly 63% of the $359 million foundations gave for health policy in 2002.
This limited investment in health services research has occurred despite growing concern about the cost (eg, double digit growth in health insurance premiums) and quality (eg, errors in medicine and failure to implement best practices) of health care in the United States.
http://jama.ama-assn.org/cgi/content/abstract/294/11/1333?etoc
Comment: Many astute observers of the health care scene are now questioning the value of much of our expensive new technological and pharmaceutical products. Although new drugs may show a slight, statistically significant superiority in clinical trials, there is genuine concern that most of these new products do not have much of an overall favorable impact on the health of the target populations, especially when compared with established, less expensive products. Also, regions which have a greater capacity for providing higher tech care have failed to demonstrate a commensurate improvement in health care outcomes (though there are isolated examples of the benefits of some interventions). The point is that our research has been targeted toward creating more profitable products rather than toward more beneficial products that provide much greater value.
In contrast, consider what improvements could be made in the overall health of our entire population if only we put in place the policies already demonstrated to be effective through health policy and health services research. The impact could be readily measured in just the number of lives saved, not to mention the reduction in human suffering. Most of these policies would cost very little and could actually result in a reduction of our global health care spending.
This is not to say that we should not be investing in biomedical research, but we should be demanding that health care consumers, who are footing the bill, receive greater value than they currently are.
Government and foundation spending in health policy and health services research has been a bargain considering the rich body of beneficial policy options that it has produced. So why aren’t we putting these policies into place?
That’s not really meant to be a rhetorical question. Perhaps we could use one more survey of the policy literature addressing this question. The political scientists could help us with the “why,” but who can help us with the “how to”?