The New Era of Comparative Effectiveness: Will Public Health End Up Left Behind?

Abstract:     
According to some optimistic accounts, comparative effectiveness research (CER) will revolutionize clinical practice and transform the health care delivery system. But what about public health? There are reasons for concern that it could end up left behind in the new era of comparative effectiveness. This article analyzes the considerable promise and serious limitations of applying CER to public health. It also highlights important issues that will likely emerge for public health law and policy as the health care system transitions to greater reliance on CER. The new national CER program, created by the Patient Protection and Affordable Care Act (PPACA), presents intriguing opportunities for improving the health of the population. At the same time, PPACA has deployed CER under conditions that leave it weakly positioned to transform public health. CER already faces translation barriers in influencing regular medical care. Even more challenging translation problems arise, however, when applying CER to the public health system. These special impediments include: PPACA's unclear legislative mandate for including comprehensive public health analysis within the national CER program, methodological difficulties in designing comparative effectiveness investigations to assess population health effects, concerns about the public/private oversight of the research, the underlying fragmentation between individual medical care and population health, and insufficient incentives for fostering physician uptake of CER.

Number of Pages in PDF File: 32

Accepted Paper Series