Congressional appropriators face difficult decisions in a time of imposed national budget constraint. However, the move by the House Appropriations Committee to terminate the Agency for Healthcare Research and Quality (AHRQ) is the wrong way to address these challenges.
In an era of austerity driven by sequestration, the desire to fund new discoveries has once again been placed in direct competition with complementary, equally critical efforts to insure equitable and safe access to these same innovations across America. I believe this is a false choice that put us all at risk by ultimately constraining both aims.
Others have cataloged the diverse activities sponsored by AHRQ and the benefits accrued. I won’t repeat them here, except to say that societal investment in AHRQ specifically, and health services research (HSR) in general, is key to designing, building, and sustaining critical infrastructure and capabilities so that the health system can work better, serving the needs of patients and those who care for them. This is not sexy work — it will not trend on Twitter, nor is it likely to make the front page of USA Today, at least not that you’d notice.
However, the problems and solutions at the heart of HSR and core to the mission of AHRQ—from health disparities to patients gaining reliable access to new discoveries—underlie some of the most compelling medical stories there are. Take, for example, the patient who gets sicker or dies because she doesn’t receive necessary and recommended medical services; the health system innovations that encourage the highest quality care; or changes in medical procedures that reduce costs and save lives.
We do and should hold leaders accountable for the folly and risk of poor infrastructure planning and investment. For example, placing new trains capable of higher speeds on tracks and control systems from the last century is unacceptable. We systematically upgrade highways and communications infrastructure as invention progresses, and we couple discovery of exciting and life-changing new technologies with assurances around broad access and safety. Innovation in health care is no less deserving of robust infrastructure investment, improvement, and spread. Yet, the move to eliminate AHRQ cripples our ability to plan and upgrade our health care infrastructure and puts our national ability to realize the full benefit of care discoveries at inappropriate risk.
Decades have been spent balancing the portfolios of the agencies that comprise the Department of Health and Human Services so that they can provide the country with an integrated approach to discovery and delivery of care improvement and innovation. This includes the identification of the causes of disease at Centers for Disease Control (CDC), the development of cures at National Institutes of Health (NIH), and the identification and dissemination of the best strategies for delivery and organization of those innovations at AHRQ.
Unlike its peers, AHRQ research is not focused on a single disease or treatment, but on the cross platform and multidimensional aspects of care delivery. AHRQ and the HSR it fosters work to make the health system function better. As such, it is charged to work with its sister agencies to “produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.”
AcademyHealth President and CEO Lisa Simpson said in her official statement, “Investments in discovery and development will fall short if we don’t have research on how best to deliver them to the right patients, at the right time, and in the right setting.” That is where AHRQ makes its greatest contributions.
In a resource limited environment, we have to make tough choices, but eliminating funding for AHRQ is short sighted and places patients and their families at inappropriate risk. AcademyHealth and our partners in the research community look to the Senate to restore funding for AHRQ and maintain a balanced portfolio of investment in research that protects and improves the health of individuals and communities across America.
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