Health Care Reform and the Need for Comparative-Effectiveness Research

Health care reform will eventually pit the goal of expanding health insurance coverage against strong pressure to reduce the growth in health care costs. If left to measures in the proposed reform legislation, cost containment will be driven primarily by marketplace incentives, programmatic initiatives, and organizational changes that would partially offset the costs of expanding coverage.1 These proposed economic policy changes and incentives, however, are not guaranteed to lead either to individual clinical decisions that will be in patients' best interests or to enhancement of the public's health. Rather, these forces are relatively blunt instruments that might nudge the health . . .