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The Role of Purchasers in the Clinical Research Enterprise
  1. Patricia R. Salber
  1. Medical Director, Managed Care, Health Care Initiatives, General Motors Corp. in conjunction with The Permanente Co., Larkspur, Calif.

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INTRODUCTION

The Institute of Medicine/s Clinical Research Roundtable discussed the role of employers in the clinical research enterprise at a workshop in December 2001. The discussion explored how the clinical research enterprise can better serve purchasers as they strive to provide high-quality, affordable health care benefits to employees, retirees, and dependents. Representatives of employers and business organizations presented their views.

VALUE VERSUS COST

Recently, the investment in health care by companies has been increasing by roughly 8 to 10% per year. A common question that corporate shareholders ask is what the company will receive from an additional investment. Do the annual increases in health care expenditures buy better health, or even better health care? Or does this money simply buy more services, regardless of their value to the company/s beneficiaries? Will the substantial incremental investment in health care that many purchasers face somehow add to the bottom line of the enterprise or add to the public good? Or will the additional dollars be spent with no return?

Some but not all purchasers are willing to differentiate and pay more for quality care because they think that high-quality health care will save money in the long run by avoiding expenditures related to poor quality (e.g., rework, redundancy, medical errors, failure to deliver evidence-based treatments with a proven record of improved clinical outcomes). They also think that quality care will improve employee satisfaction and performance in the workplace. More clinical research needs to be done, however, to determine whether these beliefs will hold under rigorous evaluation. Without this information, some purchasers may feel justified in purchasing health care solely on the basis of the best price.

TRANSLATING RESEARCH INTO CLINICAL PRACTICE

Purchasers are eager to consider ideas regarding how to improve the health care system, but they need help from the research community to identify effective tools and methodologies that promote …

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