No,You Can’t Eliminate AHRQ and
Have NIH (or Others) do AHRQ’S Work
In June, the House of Representatives Appropriations Committee voted to zero out funding for the Agency for
Healthcare Research and Quality (AHRQ), which funds studies to improve health care delivery. A proposal
from the corresponding Senate committee, also approved in June, slashed AHRQ’s $364 million budget by 35
percent. Those who want to cut or eliminate AHRQ can’t distinguish its role from that of the National Institutes of
Health (NIH) or other sister agencies within the Department of Health and Human Services. But there are several
important distinctions, and eliminating the Agency would leave a very real void in our federal research ecosystem:
1.
AHRQ and NIH focus on different parts
of the health care puzzle.
Whereas NIH focuses on efficacy—does a treatment
work in a clinical trial?—AHRQ was created in 1989
to study effectiveness. One way to think of NIH is,
“Can it work in a highly selected group of patients,”
whereas AHRQ asks the question, “How will it work
in the real world?” NIH-funded research tends to
focus on treatments for specific diseases, whereas
AHRQ looks at broader questions: How do you organize primary care practices for more effective patient
care? How about access, or out-of-pocket costs for
patients? AHRQ’s focus of inquiry is not related to a
specific disease.
2.
In fact, AHRQ does things no other agency
does—specifically, finding waste in the
healthcare system.
A 2011 Institute of Medicine report found that 30
percent of the $2.5 trillion the United States spends
annually on health care is wasted on unnecessary
services and other needless costs. AHRQ is designed to find waste and fraud in our health care
spending—and help figure out how to eliminate it. In
addition, AHRQ funds annual reports on the quality
of U.S. health care, supports training of health services researchers, and works to disseminate research
findings on the best treatments. These are not projects undertaken by NIH or other agencies.
3.
Lawmakers clearly value AHRQ’s work—that’s
why it was referenced in more than 50 bills this
term—but are failing to fund it adequately.
AHRQ is essential to realizing the full potential of our
research investments, and lawmakers know it—that’s
why AHRQ is named in more than 50 bills this term.
But funding for AHRQ continues to be slashed.
Without new money or clear authority, no one else
will do AHRQ’s work. The House bill moves some
of AHRQ’s work to NIH and CDC, without providing
any new money. In this austere environment where
everyone is doing more with less, it’s naïve to think
that other agencies will carve out money from their
existing limited resources to fund a separate agency’s portfolio.
Need More Convincing? Don’t Just Take Our Word for It.
“I’m glad we have AHRQ. I can’t imagine why anyone would
want to defund it.”
– Alice Rivlin, 2015 AHRQ Research Conference
“As an elected official, I’m all too aware that politics can get in the way of
progress. But putting health services research in the crosshairs is misguided
and unconscionable. Tens of thousands of lives have been saved by this research; how many more lives could be saved by continuing to fund AHRQ?”
– Rep. Lucille Royball-Allard, The Hill
“Eliminating or gutting the agency that focuses on these issues and on ways to
reduce health care spending and improve quality could hardly come at a less
opportune time. Everyone in Congress, including Republicans who want to improve
or replace the ACA, should be interested in gaining a better understanding of the
ACA’s effects and the likely effects of any proposed alternatives to the law.”
– Gail Wilensky, JAMA Forum
“I had run on a platform of fiscal discipline, so why should I be concerned
with the elimination of a little-known health agency? And yet it made no
sense to get rid of the very agency...whose mission was to find ways to
improve health care quality and outcomes and reduce costs.”
–Former Senator Bill Frist, Forbes “The agency sponsors a broad range of health services research on how health
care is delivered and paid for in this country...We may not be enthralled by a study
of how to prevent hospital-based infections, but such studies can change the way
health care is delivered on the ground--which can improve patient experience and
reduce cost.”
– Joe Antos, AEI