The mission of the Agency for Health Care Policy and Research (AHCPR)
is to generate and disseminate information that improves the delivery
of health care. This mission is unique. AHCPR's research goals are
to determine what works best in clinical practice; improve the cost-effective use of health care resources; help consumers make more
informed choices; and measure and improve the quality of care. These
goals were developed to explicitly address the major changes
affecting health care and the role of government.
Today, rapid changes in the health care system are dramatically
altering the services available to both publicly and privately
insured patients. Managed care is restructuring delivery to rely
more heavily on primary care services and providers with largely
unknown impact on cost and quality. The increasing complexity of the
choices facing patients, physicians, health plans, and purchasers has
resulted in an explosion in the need for the knowledge, measures, and
tools of health services research. Patients, providers, purchasers,
and plans that make decisions about health care services in an
increasingly market-sensitive health care system require information
about their options to improve health outcomes and effectiveness.
In
addition to informing decisionmakers about the effectiveness,
outcomes, and quality of clinical services, health services research
also informs decisionmakers about the impact of changes in the
organization and financing of health care. This is particularly
relevant today, when competition is altering the nature and content
of primary care services. Thus, the science base developed by AHCPR
serves as the key navigational tool for decisions at each of these
levels of decisionmaking about health care.
The fiscal year 1999 request totals $171,435,000, an increase of $25,000,000
over the fiscal year 1998 appropriation. In budget authority, the fiscal year 1999
request totals $100,788,000, an increase of $10,559,000 over the fiscal year
1998 appropriation. An additional $70,647,000 is requested in one-percent evaluation funds.
- Budget Authority ............................. $100,788,000
- One-percent Evaluation Funds.................. $ 70,647,000
- Total, Program Level.......................... $171,435,000
For background information, select Appropriation History Table.
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The fiscal year 1999 request supports the established goals of the
Department of Health and Human
Services (HHS), principally Goal 4: Improving Quality, and Goal 6:
Strengthening the Science Base. Specifically, AHCPR's research is
designed to focus on four areas:
- Improving clinical practice. Clinicians, patients and health
care institutions need information about what works, for whom,
when, and at what cost.
- Improving health care systems. Medical practices, hospitals
and other institutions, health networks, and plans need
information to improve the health care system's capacity to
deliver quality care.
- Tracking the Nation's progress. Policymakers at all levels
of government as well as private-sector policymakers need
more information to monitor and evaluate the impact of system
changes on access, cost, and use of health care.
- Improving activities that support all areas of research. These include
dissemination; cost effectiveness analysis; priority
populations including minority and ethnic groups, women,
children, and the elderly; and health services research
training.
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All four areas of research are targeted through our budget activity
research on Health Costs, Quality, and Outcomes (HCQO). This is a
new budget activity; the fiscal year 1999 request proposes to change
activity structure and activity titles to reflect the integration
that has occurred in AHCPR's research due to enormous changes in
the health care market that place a growing emphasis on quality in
the health care system.
| Current Budget Activity | Proposed Budget Activity |
|
Research on Health Care Systems Cost and access (HCSCA) | Research on Health Costs,
Quality, and Outcomes (HCQO) |
|
Research on Health Care Outcomes and Quality (HCOQ) | Included in HCQO
|
|
Health Insurance and Expenditure Surveys (HIES) | Medical Expenditure Panel
Survey (MEPS)
|
|
Program Support | Program Support |
Research on Health Costs, Quality, and Outcomes (HCQO) funds
research and development of tools to improve the functioning of the
health care system. Whether at the level of an individual patient
and clinician confronting discrete care choices, a medical director
of a managed care plan caring for a defined population, a State
official addressing the health needs of entire communities, or
public and private purchasers seeking value for their health care
dollar, health services research answers the enduring central
questions: What works? Under what circumstances? For which
conditions? At what cost?
For details from the justification, select Research on Health Costs, Quality, and Outcomes (25 KB).
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AHCPR's Medical Expenditure Panel Survey (MEPS) provides public and
private-sector decisionmakers with the ability to obtain timely
national estimates of health care use and expenditures, private and
public health insurance coverage, and the availability, costs, and
scope of private health insurance benefits among the U.S.
population. Using the information from MEPS, AHCPR provides
analysis of changes in behavior as a result of market forces or
policy changes on health care use, expenditures, and insurance
coverage; develops cost/savings estimates of proposed changes in
policy; and identifies the impact of changes in policy for key
sectors of the industry (e.g., primary care)and important subgroups
of the population (i.e., who benefits and who pays more).
For details on MEPS from the justification, select Medical Expenditure Panel Survey (23 KB).
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Program Support provides support for the overall direction and management of
the AHCPR. This includes the formulation of policies and program
objectives; program planning and evaluation; grants and contracts
management; resource management; and administrative management and
services activities.
Select for details about Program Support (3 KB).
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The fiscal year 1999 request includes funding for commitments and provides
for new extramural research in areas such as outcomes and
effectiveness research; measuring quality; research on health care
markets, organization, and delivery; evidence-based practice
research; pharmaceutical research; and health services research
training. The request also includes continued funding for the
Medical Expenditure Panel Survey
(MEPS) at $27,800,000 (a reduction
of $8,500,000 from the fiscal year 1998 level) to be used for new and
enhanced research on minority health, women's health, and cost
effectiveness analysis.
The increase of $25,000,000 over the fiscal year 1998 appropriation will
support:
- Improving Health Care Quality: $15,000,000
- Key Emphasis Areas: $10,000,000
- Improving Outcomes for Elderly and Chronically Ill ($5,000,000).
- Clinical Preventive Services ($2,000,000).
- Centers for Education and Research Therapeutics ($1,000,000).
- Children's Health ($2,000,000).
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The Government plays a number of key roles in improving health care
quality. As the major purchaser of health care services, the
Government has a responsibility to make effective use of its
purchasing power to ensure that the individuals it serves receive
quality health care services at a reasonable price. As a leading
provider of health care services, the Government has the
responsibility to ensure that its programs continuously assess and
improve the quality of care that they provide. As the leading
supporter of health research, the Government has the responsibility
to provide the objective scientific information that Americans need
to make more informed health care choices, to determine the
outcomes and effectiveness of health services, to develop and
validate measures of quality, and to determine effective ways to
improve the quality of health care.
The Secretarial Quality Initiative will:
- Facilitate Consumers' Use of Information on Quality.
Consumers seldom have the information they need to make
informed decisions about health plans, providers, and
treatments. In a market-driven health care system, informed
decisions will lead to better quality care. This initiative
will help determine the outcomes and effectiveness of health
care services and enable consumers to understand and use
quality information effectively.
- Strengthen Value-Based Purchasing by the Department. This
initiative will use the Department's power as a major health
care purchaser to ensure high quality care through prudent,
value-based purchasing decisions. The Department will use key
elements in purchasing, such as payment criteria, contract
specifications, performance measures to assess health care
quality, and standards for access to culturally competent
providers and adequate provider networks. This initiative
will also set a framework for other purchasers of care to be
value based, to focus on performance, and to emphasize
quality.
- Improve the Quality of Health Care Services Delivered Directly
by HHS Programs. The Department provides direct care
through many programs, each of which has its own quality
improvement activities. This initiative will identify quality
improvement strategies that work and promote their adoption
across these programs.
- Expand Research that Improves Quality. The Department has a
substantial portfolio of research on quality of care, but
translating that knowledge base into concrete improvements in
health care is still a challenge. This initiative will
support research to measure quality of care, particularly
those elements of quality that are important to the public, to
use health outcomes to assess care, and to develop and
determine which quality improvement methods work, and in which
settings. It will also support research to understand how to
redesign the tasks of delivering care, to eliminate
unnecessary steps and minimize the chances for error.
- Measure National Health Care Quality. Little objective
information currently exists to determine what is happening to
the overall quality of health care in America. Under this
initiative the Department will build upon existing data
reporting systems to provide an ongoing picture of the state
of health care quality, an early warning system for quality
problems, and opportunities for improvement.
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The growing size of the elderly population presents a demographic
shift of monumental proportions that will have a dramatic impact on
the cost and organization of health care. The health needs of the
elderly are largely driven by the occurrence of chronic illness and
disability; hence, health services research for this important
population will be focused on the cost, quality, and outcomes of
care for chronic illness and disability. At the same time, others
remain active and in the workforce with the expectation that their
chronic illness will be adequately managed by the health care
system. The growing demands being placed on long-term and home-care facilities have also raised questions about the adequacy,
cost, and quality of these services.
Chronic disease is the main cause of disability in this country,
the number one reason that people use health services, and accounts
for 70 percent of health care resources. Yet the health care
system is arranged largely for acute care. There is growing
evidence that this structure is neither efficient nor particularly
effective at meeting the needs of persons with chronic and
disabling conditions and is not cost-effective. The challenge
here is to determine what works best in providing high-quality,
cost-effective care, whether in the acute, ambulatory setting, long-term care, or home-based settings.
This initiative will:
-
Develop a "toolbox" of well-defined and validated measurement
instruments, including a core set of outcomes measures to
address the top conditions paid for by Medicare, that have
been specifically tested for use in older individuals in
different health care settings, including managed care and fee
for services.
- Examine how various system characteristics—including how
physicians are compensated, which services are "carved-out"
and provided separately, and the degree of clinical
integration—affect the health outcomes for the elderly and
chronically ill including studies to identify the most cost-effective solutions for both the Medicare and Medicaid
populations.
- Include a specific focus on the health outcomes and needs of
racial and ethnic minorities and women, who represent a large
and growing proportion of this population.
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There is great interest among providers and patients in the
delivery of the full range of appropriate preventive
care—screening tests for the early detection of disease, advice to
help people change their risky health-related behaviors, and
immunizations to prevent infections. These interventions have
enormous potential to improve the health of the American people,
but without careful assessment of what works and what doesn't,
costs could be astronomical. This initiative will support two-to-four major new assessments of preventive services and updates of
priority topics, providing targeted, timely information to help
providers and patients make appropriate decisions on preventive
services.
AHCPR also will sponsor the "Put Prevention into Practice"
initiative, which creates and disseminates tools for providers,
health systems, and patients to improve delivery and receipt of
these preventive care recommendations.
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The recently-passed Food and Drug Administration Modernization and
Accountability Act of 1997 includes new responsibilities for AHCPR.
A level of $1,000,000 will allow AHCPR to make grants to support
the establishment and operation of two Centers for Education and
Research Therapeutics (CERTs). The CERTs will increase the
awareness of new uses and risks of medical products; provide
information to health care participants to help them use new
products most effectively; improve the appropriate use of medical
products by health professionals; and prevent adverse effects of
medical products and the consequences of these effects.
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With the passage of the State Child Health Insurance Program (SCHIP)
as part of the Balanced Budget Act of 1997, the Nation is once
again focused on health care for children and adolescents,
especially those in low-income families. The passage of SCHIP
provides a landmark opportunity to develop and apply tools to
measure and improve the quality of care for children in this
country. This initiative will support:
- Applied research and demonstrations to develop a toolbox of
measures, instruments, and proven strategies to improve
quality and outcomes of care.
- Outcomes research on the most important challenges in
children's health.
- Research and evaluations on the impact of various State and
local approaches to implementing the SCHIP legislation to
identify evidence-based practices.
- Dissemination of findings and technical assistance to states,
providers, and communities about what works in improving child
health.
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MEPS funding totaling $27,800,000 is included in the fiscal year 1999
request. No other surveys provide the foundation for estimating
the impact of changes on different economic groups or special
populations of interest, such as the poor, elderly, veterans, the
uninsured, or racial/ethnic groups. The data from MEPS will help
reach the objective of assuring the long-term solvency and
integrity of Medicare by providing information for analysis on
financing implications of proposed changes to Medicare.
In fiscal year 1999, data collection will be ongoing for the MEPS Household
Survey, the MEPS Medical Provider Survey, and the MEPS Insurance
Component (which consists of the MEPS Health Insurance Plans Survey
and a national employer health insurance survey). All of the MEPS
components will be heavily engaged in survey-related activities
directed to the following tasks: data editing, imputation, data
preparation and data processing, development of estimation weights
and variance estimation capabilities for the component surveys,
preparation of public use tapes, and development of analytical and
methodological reports.
Select MEPS for details from the justification.
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Current as of February 1998
Internet Citation:
Justification for Budget Estimates for Appropriations Committees, Fiscal Year 1999. Agency for Health Care Policy and Research, Rockville, MD.
http://www.ahrq.gov/about/cj1999/cjweb99.htm
540 Gaither Road Rockville, MD 20950